Application value of 3.0T magnetic resonance imaging in carotid atherosclerotic plaque composition examination of ischemic stroke
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摘要:
目的 探究3.0 T MRI在缺血性脑卒中颈动脉粥样硬化斑块成分检查中的临床应用。 方法 选择我院及上海交通大学附属第六人民医院2020年6月~2021年4月收治的62例因颈动脉粥样硬化所致的缺血性脑卒中患者作为研究对象。采用3.0 T MRI对所有患者颈动脉血管狭窄处的斑块成分及不同类型斑块的信号特征进行观察、分析，对比稳定斑块、不稳定斑块组成成分的差异。 结果 共发现颈动脉粥样硬化斑块119个，斑块分型：Ⅰ~Ⅱ型11个（9.24%），Ⅲ型31个（26.05%），Ⅳ~Ⅴ型24个（20.17%），Ⅵ型37个（31.09%），Ⅶ型16个（13.45%）。所有斑块在MRI上均表现为环形或偏心性管壁增厚，且部分伴有局部新月形或半月形信号突入管腔，不同成分斑块在MRI上的表现各有所不同。所有检出的颈动脉斑块中稳定斑块共计62个，不稳定斑块57个。稳定斑块和不稳定斑块出现钙化的差异无统计学意义（P > 0.05），不稳定斑块出现脂质核心、出血、血栓形成以及纤维帽破裂的比例高于稳定斑块，差异有统计学意义（P < 0.05）。 结论 3.0 T MRI能够对缺血性脑卒中患者的颈动脉粥样硬化斑块内部成分及稳定性作出准确评价，可为缺血性脑卒中的临床预测及病情评价提供重要参考。 Abstract:Objective To explore the clinical application of 3.0T MRI in carotid atherosclerotic plaque composition examination of ischemic stroke. Methods Sixty-two patients with ischemic stroke caused by carotid atherosclerosis in our hospital and Shanghai Jiaotong University affiliated sixth People's Hospital from June 2020 to April 2021 were selected. 3.0T MRI was used to observe and analyze the plaque composition and signal characteristics of different types of plaques in all patients with carotid artery stenosis. The difference between stable plaque and unstable plaque composition was compared. Results A total of 119 carotid atherosclerotic plaques were found in 62 patients. Patch classification: 11 cases were type Ⅰ-Ⅱ (9.24%), 31 cases were type Ⅲ (26.05%), 24 cases were type Ⅳ-Ⅴ (20.17%), 37 cases were type Ⅵ (31.09%), 16 cases were type Ⅶ (13.45%). All plaques showed annular or eccentric wall thickening on MRI, and some of them were accompanied by local crescent or semilunar signal penetrating into the lumen. The manifestations of plaques with different components were different on MRI. There were 62 stable plaques and 57 unstable plaques in all detected carotid plaques. There was no significant difference in the proportion of calcification between stable plaque and unstable plaque (P > 0.05). The proportion of lipid core, hemorrhage, thrombosis and fibrous cap rupture in unstable plaque was significantly higher than that in stable plaque (P < 0.05). Conclusion 3.0T MRI can accurately evaluate the internal composition and stability of carotid atherosclerotic plaques in patients with ischemic stroke. It provide important reference for clinical prediction and disease evaluation of ischemic stroke. -
图 1 颈总动脉侧壁增厚明显
3D-TOF（A）和FSE-T2WI（B）显示稍低信号, DIR-T1WI（C）显示稍高信号, PDWI（D）显示等信号, 增厚的管壁内可见点状高低混杂信号, 多为含有纤维和脂质成分的复杂斑块.
Figure 1. The lateral wall of the common carotid artery is obviously thickened.
图 2 颈内动脉斑块内新鲜出血并伴有血栓形成
新鲜出血在3D-TOF（A）、FSE-T2WI（B）、DIR-T1WI（C）、PDWI（D）均呈高信号.
Figure 2. Fresh bleeding in the internal carotid plaque with thrombosis.
图 3 颈内动脉纤维帽破裂
3D-TOF（A）显示破裂处有高血流信号，FSE-T2WI（B）、DIR-T1WI（C）、PDWI（D）显示破裂纤维帽局部向腔内突出.
Figure 3. Rupture of the internal carotid artery fibrous cap.
表 1 3.0 T MRI扫描序列及参数
Table 1. 3.0 T MRI scanning sequence and parameters
扫描参数 3D-TOF FSE-T1WI FSE-T2WI PDWI TR(ms) 29 800 3000 3000 TE(ms) 2.1 8.9 13.1 57 FOV(cm) 14×14 14×14 14×14 14×14 层厚(mm) 2.0 2.0 2.0 2.0 层间距(mm) 1.0 1.0 1.0 1.0 矩阵 256×256 288×192 384×256 384×256 激励次数 1 2 2 2 3D-TOF: 三维时间飞跃法; FSE: 快速自旋回波; PDWI: 质子密度加权像. 
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表 2 不同成分斑块在MRI各序列上的信号表现
Table 2. Signal manifestions of plaques wity different components on MRI sequences
斑块成分 3D-TOF DIR-T1WI FSE-T2WI PDWI 脂质核心 等信号 等/稍低信号 稍低信号 等/稍低信号 出血 高信号 高信号 高信号 高信号 血栓 低信号 低信号 低信号 低信号 钙化 点条状低信号 点条状低信号 点条状低信号 点条状低信号 纤维帽破损 等/稍低信号 等/稍高信号 高信号 等/稍高信号
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表 3 稳定性斑块和不稳定斑块的组成成分差异比较
Table 3. Comparison of composition differences between stable plaque and unstable plaque[n(%)]
斑块稳定性 含脂质核心 伴出血 形成血栓 含有钙化 纤维帽破裂 稳定斑块（n=62） 15(24.19) 7(11.29) 0(0.00) 12(19.35) 4(6.45) 不稳定斑块（n=57） 36(63.16) 23(40.35) 14(24.56) 15(26.32) 20(35.09) χ2 18.4107 13.3018 17.2585 0.8203 15.1254 P < 0.001 < 0.001 < 0.001 0.3651 < 0.001
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