椎动脉优势与基底动脉形态及斑块特征间的关系：基于磁共振高分辨率血管壁成像

陈文静; 沈龙山

doi:10.12122/j.issn.1674-4500.2024.10.05

椎动脉优势与基底动脉形态及斑块特征间的关系：基于磁共振高分辨率血管壁成像

doi: 10.12122/j.issn.1674-4500.2024.10.05

陈文静^{1, 3,},
沈龙山^{1, 2, 3, ,}

1.
上海市第一人民医院蚌埠医院（蚌埠医科大学第二附属医院）放射科，安徽蚌埠 233040
2.
蚌埠医科大学医学影像学院，安徽蚌埠 233030
3.
数字医学与智慧健康安徽普通高校重点实验室（蚌埠医科大学），蚌埠医科大学临床应用解剖研究所，安徽蚌埠 233004

基金项目:

安徽省重点实验室开放课题 AHCM2023W001

数字医学与智慧健康安徽普通高校重点实验室（蚌埠医学院）一般项目 AHCM2022W001

详细信息

作者简介:
陈文静，在读硕士研究生，住院医师，E-mail：2595222799@qq.com

通讯作者:
沈龙山，硕士生导师，主任医师，E-mail：trede@163.com

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- 被引次数: 0
出版历程
- 收稿日期: 2024-07-16
- 网络出版日期: 2024-11-02
- 刊出日期: 2024-10-20

Relationship between vertebral artery dominance and basilar artery morphology and plaque characteristics: based on high-resolution vessel wall imaging

CHEN Wenjing^{1, 3
,},
SHEN Longshan^{1, 2, 3
, ,}

1.
Department of Radiology, Shanghai First People's Hospital Bengbu Hospital (The Second Affiliated Hospital of Bengbu Medical College), Bengbu Medical College, Bengbu 233040, China
2.
School of Medical Imaging, Bengbu Medical College, Bengbu 233030, China
3.
Key Laboratory of Digital Medicine and Intelligent Health of Anhui General Colleges and Universities (Bengbu Medical College), Institute of Clinical Applied Anatomy, Bengbu Medical College, Bengbu 233004, China

摘要

摘要: 目的通过磁共振高分辨率血管壁成像（HR-VWI）研究椎动脉优势（VAD）与非VAD患者基底动脉的形态、斑块分布及强化方式的差异。方法回顾性分析2022年6月~2024年3月蚌埠医科大学第附属二医院行磁共振HR-MRI检查的100例患者的临床资料及基底动脉形态、斑块特征。采用三维时间飞跃法磁共振血管造影正位视图，将患者分为VAD组（n=77）和非VAD组（n=23）；测量椎动脉直径及基底动脉的直径、长度、弯曲方向和弯曲程度等参数。利用HR-VWI图像分析斑块的分布及强化程度，计算狭窄程度、重构指数及斑块负荷。结果两组患者一般资料的差异无统计学意义（P＞0.05）。两组间基底动脉的弯曲方向、弯曲程度及斑块的分布和强化程度差异均有统计学意义（P＜0.05）。VAD组基底动脉多向右侧弯曲。VAD组基底动脉的弯曲程度1级和3级占比较大，而非VAD组则主要集中在0级。VAD组斑块横向分布多位于腹侧壁（P=0.010），纵向分布多为远端斑块（P=0.047）。VAD组中斑块2级强化的比例显著高于非VAD组（P＜0.05）。结论 HR-VWI作为一项无创性核磁共振技术，可以清晰地显示椎-基底动脉的几何状态、血管壁及动脉粥样硬化斑块，定性或定量评估斑块特征和血管的重构状况、狭窄率等；椎动脉优势显著影响基底动脉的弯曲方向、弯曲程度及斑块的分布和强化程度。
- 椎动脉优势 /
- 基底动脉 /
- 磁共振高分辨率血管壁成像 /
- 斑块
Abstract: Objective To investigate differences in basilar artery morphology, plaque distribution, and enhancement patterns between vertebral artery dominance (VAD) and non-VAD patients using high-resolution vessel wall imaging (HR-VWI). Methods A retrospective analysis was conducted on clinical data and basilar artery morphology and plaque characteristics in 100 patients who underwent HR-MRI at the Second Affiliated Hospital of Bengbu Medical College from June 2022 to March 2024. Utilizing 3D time-of-flight magnetic resonance angiography, VAD group (n=77) and non-VAD group (n=23) were examined. Measurements included vertebral and basilar artery diameters, lengths, curvature direction, and degree. Plaque distribution and enhancement were analyzed using HR-VWI, calculating stenosis degree, remodeling index, and plaque burden. Results Clinical data showed no significant differences between the two groups (P>0.05). Significant differences were found in basilar artery curvature direction, degree, plaque distribution, and enhancement (P<0.05). In the VAD group, basilar artery curvature was predominantly rightward, with higher proportions of grade 1 and 3 curvature, while the non-VAD group mainly had grade 0 curvature. Plaque was more often distributed on the ventral wall (P=0.010) and distally (P=0.047) in the VAD group. Grade 2 plaque enhancement was significantly higher in the VAD group compared to the non-VAD group (P<0.05). Conclusion In VAD patients, the basilar artery predominantly curves to the right, with a higher proportion of moderate to severe curvature compared to non-VAD patients. Plaques in the basilar artery are more frequently located on the ventral wall and distally, with a more pronounced enhancement degree in VAD patients. Vertebral artery dominance significantly influences the direction and degree of basilar artery curvature, as well as plaque distribution and enhancement.
- vertebral artery dominance /
- basilar artery /
- high-resolution vessel wall imaging /
- plaque

HTML全文

图 1 在3D-TOF-MRA正位视图测量椎动脉、基底动脉直径及长度、基底动脉弯曲程度

Figure 1. Measurement of vertebral artery and basilar artery diameter and length and degree of basilar artery curvature in 3D-TOF-MRA upright view. A: For non-vertebral artery dominance patients, the diameter of the right vertebral artery was 0.19 cm, and the diameter of the left vertebral artery was 0.20 cm, while the diameter of the basilar artery was 2.34 cm; B: For vertebral artery dominance patients, there was severe bending of the basilar artery with a horizontal distance of 0.71 cm.

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图 2 斑块的横向分布及纵向分布

Figure 2. Lateral and longitudinal distribution of patches. A: Longitudinal plaque distribution, located distally. B: Transverse plaque distribution, located ventrally.

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图 3 在HR-VWI T1增强图像勾画非VAD患者的基底动脉血管

Figure 3. Delineation of basilar arteries in non-VAD patients in HR-VWI T1 enhanced images. A: Reference level vascular area. B: Reference level lumen area.

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图 4 在HR-VWI T1增强图像勾画VAD患者的基底动脉血管

Figure 4. Delineating the basilar arteries in VAD patients in HR-VWI T1 enhanced images. A: Narrowest level vascular area. B: Narrowest level lumen area. Significant plaque, with eccentric thickening of the basilar artery wall.

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表 1 非VAD组与VAD组临床相关因素及实验室指标比较

Table 1. Comparison of clinical related factors and laboratory indicators between the non-VAD group and the VAD group

Factors	Non-VAD group (n=23)	VAD group (n=77)	t/χ²/Z	P
Age (year, Mean±SD)	61±12	59±12	0.713	0.478
Gender [male, n(%)]	13(56.5)	57(74)	2.584	0.108
Smoking [n(%)]	4(17.4)	16(20.8)	0.127	0.722
Alcoholism [n(%)]	10(43.5)	38(49.4)	0.245	0.621
Hypertension [n(%)]	18(78.3)	63(81.8)	0.146	0.703
Diabetes mellitus [n(%)]	8(34.8)	39(50.6)	1.790	0.181
Total cholesterol (mmol /L, Mean±SD)	4.26±1.40	4.38±1.62	-0.302	0.764
Triglycerides (mmol/L, Mean±SD)	2.00±1.00	2.03±0.88	-0.156	0.876
High density lipoprotein (mmol/L, Mean±SD)	1.05±0.27	1.14±0.41	-0.997	0.321
Low density lipoprotein (mmol/L, Mean±SD)	2.31±1.16	2.45±1.28	-0.480	0.633
VA: Vertebral artery; BA: Basilar artery.

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表 2 非VAD组与VAD组基底动脉形态学比较

Table 2. Comparison of basilar artery morphology between non-VAD group and VAD group

Items	Non-VAD group (n=23)	VAD group (n=77)	t/χ²/Z	P
BA diameter (cm, Mean±SD)	0.30±0.06	0.31±0.07	-0.814	0.418
BA length (cm, Mean±SD)	2.40±0.35	2.58±0.47	-1.654	0.101
BA bending direction [n(%)]
No bending	11(47.8)	4(5.2)
Right side	9(39.1)	46(59.7)	25.688	＜0.001
Left side	3(13.0)	27(35.1)
BA bending degree [n(%)]
Grade 0	18(78.3)	10(13.0)
Grade 1	4(17.4)	30(39.0)
Grade 2	0(0.0)	12(15.6)	38.343	＜0.001
Grade 3	1(4.3)	25(32.5)
VA type [n(%)]
Type 1	21(91.3)	0(0.0)
Type 2	0(0.0)	14(18.2)	89.054	＜0.001
Type 3	2(8.7)	63(81.8)
VA: Vertebral artery; BA: Basilar artery.

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表 3 非VAD组与VAD组斑块基本特征比较

Table 3. Comparison of basic plaque characteristics between non-VAD group and VAD group

Plaque characteristics	Non-VAD group (n=23)	VAD group (n=77)	t/χ²/Z	P
Reference level vascular area [mm², M(P₂₅, P₇₅)]	20.24(15.16，23.26)	20.49(16.07.24.71)	-0.692	0.489
Reference level lumen area (mm², Mean±SD)	11.64±0.03	12.93±5.45	-1.087	0.280
Narrowest level vascular area (mm², Mean±SD)	21.06±4.97	25.38±8.35	-2.355	0.020
Narrowest level lumen area (mm², Mean±SD)	10.24±2.91	6.95±3.66	3.953	＜0.001
Remodeling index (Mean±SD)	1.05±0.15	1.27±0.49	-2.028	0.045
Plaque burden (%, Mean±SD)	0.51±0.12	0.72±0.12	-7.649	＜0.001
Stenosis rate (%, Mean±SD)	0.12±0.06	0.45±0.18	-8.503	＜0.001
Maximum wall thickness (mm, Mean±SD)	2.00±0.62	1.95±0.53	0.366	0.715

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表 4 非VAD组与VAD组斑块分布及强化程度比较

Table 4. Comparison of plaque distribution and enhancement degree between non-VAD group and VAD group [n(%)]

Items	Non-VAD group (n=23)	VAD group (n=77)	t/χ²/Z	P
Longitudinal plaque distribution			6.573	0.010
Proximal	11(47.8)	16(20.8)
Distal	12(52.2)	61(79.2)
Transverse plaque distribution			7.970	0.047
Right side	7(30.4)	15(19.5)
Ventral side	3(13.0)	32(41.6)
Left side	4(17.4)	15(19.5)
Dorsal side	9(39.1)	15(19.5)
Enhancement pattern			9.756	0.008
Grade 0	10(43.5)	16(19.5)
Grade 1	13(56.5)	43(55.8)
Grade 2	0	19(24.7)
Embryonic-type posterior cerebral artery			0.950	0.622
None	16(69.6)	48(62.3)
Partial	4(17.4)	21(27.3)
Complete	3(13.0)	8(10.4)

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