大脑中动脉粥样硬化斑块磁共振高分辨率 血管壁成像特征与缺血性脑卒中的关系

Relationship between High Resolution Vessel Wall Imaging Features and Ischemic Stroke in Atherosclerotic Plaques in the Middle Cerebral Artery

摘要:

〔摘 要〕 目的：探讨大脑中动脉（MCA）粥样硬化患者磁共振高分辨率血管壁成像（HR–VWI）特征与缺血性 脑卒中的关系。方法：回顾性纳入 2020 年 1 月至 2022 年 1 月深圳市龙华区人民医院神经内科收治的缺血性脑卒中患 者，进行头颅常规磁共振成像（MRI）及 MCA 最狭窄处 HR–VWI。比较急性缺血性脑卒中组和非急性缺血性脑卒中 组 MCA 狭窄处的血管和斑块特征。应用多因素 logistic 回归分析确定急性缺血性脑卒中的独立危险因素，应用受试 者工作特征（ROC）曲线确定血管壁特征对急性缺血性卒中的预测价值。结果：共纳入 59 例存在 MCA 狭窄的缺血 性脑血管病患者。患者年龄（52.13 ± 12.25）岁，男性 47 例（79.7 %）。急性缺血性脑卒中组 44 例（74.6 %），非 急性缺血性脑卒中组 15 例（25.4 %），两组人口统计学资料、血管危险因素比较，差异均无统计学意义（P ＞ 0.05）。 与非急性缺血性脑卒中组比较，急性缺血性脑卒中组明显强化斑块（81.8 % 对 53.3 %）更多，两组斑块分布以腹侧壁 （35.6 %）、下侧壁（27.1 %）最常见。多因素 logistic 回归分析显示，斑块明显强化程度〔OR = 6.000，95 % CI（1.116， 32.246），P ＜ 0.05〕、管腔重度狭窄〔OR = 17.417，95 % CI（1.987，152.675），P ＜ 0.001〕是急性缺血性脑卒中的 独立危险因素。ROC 曲线分析显示，斑块强化程度和管腔狭窄程度二者联合的预测效能最佳〔曲线下面积 0.851，95 % CI（0.711，0.962）〕。结论：当 MCA 最狭窄处斑块明显强化并且管腔存在重度狭窄时最易发生急性缺血性脑卒中。

Abstract:

〔Abstract〕 Objective To investigate the relationship between high resolution vessel wall imaging (HR-VWI) features and ischemic stroke in patients with middle cerebral artery (MCA) atherosclerosis. Methods Patients with ischemic stroke admitted to the Department of Neurology of Shenzhen Longhua District People's Hospital from January 2020 to January 2022 were retrospectively included. Conventional magnetic resonance imaging (MRI) of the head and HR-VWI at the narrowest point of MCA were performed. The vascular and plaque characteristics of MCA stenosis were compared between acute ischemic stroke group and non-acute ischemic stroke group. Multivariate logistic regression analysis was used to determine the independent risk factors for acute ischemic stroke, and receiver operating characteristics (ROC) curve was used to determine the predictive value of vascular wall characteristics for acute stroke. Results A total of 59 ischemic cerebrovascular patients with MCA stenosis were included. The patients were (52.13 ± 12.25) years old, and 47 (79.7 %) were males. There were 44 cases (74.6 %) in the acute ischemic stroke group and 15 cases (25.4 %) in the non-acute ischemic stroke group. There was no significant difference in demographic data and vascular risk factors between the two groups (P > 0.05). Compared with the non-acute ischemic stroke group, there were more enhanced plaques in the acute ischemic stroke group (81.8 % vs. 53.3 %), and plaques in the ventral wall (35.6 %) and inferior wall (27.1 %) were the most common in the two groups. Multivariate logistic regression analysis showed significant plaque enhancement [OR = 6.000，95 % CI (1.116，32.246), P＜0.05] and severity of luminal stenosis [OR = 17.417, 95 % CI (1.987, 152.675), P＜0.001]was an independent risk factor for acute ischemic stroke. ROC curve analysis showed that the combination of plaque enhancement degree and luminal stenosis degree had the best predictive efficacy [area under curve 0.851, 95 % CI (0.711, 0.962)]. Conclusion Acute ischemic stroke is most likely to occur when there is significant plaque enhancement at the narrowest MCA and severe lumen stenosis.