中国实用外科杂志

中国实用外科杂志

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颈动脉支架成形术前应用非增强多对比高分辨磁共振斑块成像评估价值研究

赵格非，符伟国，唐    骁，史振宇，王利新，李炜淼，唐涵斐，郭大乔   

  1. 复旦大学附属中山医院血管外科 复旦大学血管外科研究所，上海市 200032
  • 出版日期:2018-12-01 发布日期:2018-12-06

  • Online:2018-12-01 Published:2018-12-06

摘要：

目的    分析非增强多对比高分辨磁共振成像技术在颈动脉支架成形术（CAS）术前评估中的应用价值。方法    回顾性分析2017年1 月至2018 年3月在复旦大学附属中山医院接受颈动脉狭窄接受治疗的181例病人资料，通过单因素和多因素Logistic回归分析明确颈动脉斑块性质与CAS术后脑梗死病灶的关系。结果    共纳入接受CAS手术病人181例，其中术后63例（34.8%）出现无症状性新发弥散加权成像（DWI）病灶，2例（1.1%）出现有症状性脑梗死。病人Logistic回归分析结果显示颈动脉斑块内出血是预测CAS术后的无症状DWI病灶的独立危险因素（IPH）（亚急性期IPH vs. 无IPH：OR=9.393；95%CI 4.431~19.911）。结论    术前应用非增强多对比高分辨磁共振成像对斑块成分进行评估可以发现斑块不稳定成分，对CAS手术病例的选择有重要的潜在价值。

关键词: 颈动脉狭窄, 磁共振成像, 颈动脉支架成形术, 斑块

Abstract:

Evaluation of the value of non-enhanced multi-contrast high-resolution magnetic resonance plaque imaging before carotid stenting        ZHAO Ge-fei, FU Wei-guo, TANG Xiao, et al. Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032，China
Corresponding author：GUO Da-qiao，E-mail：guo.daqiao@zs-hospital.sh.cn
Abstract    Objective    To analyze the application value of non-enhanced multi-contrast high-resolution magnetic resonance imaging in preoperative evaluation of CAS. Methods    The clinical medical records of patients with carotid stenosis treated at Zhongshan Hospital,Fudan University from January 2017 to March 2018 were analyzed retrospectively.The relationship between carotid plaque characteristics and cerebral infarction lesions after CAS were confirmed by univariate and multivariate logistic regression analysis. Results    A total of 181 CAS patients were enrolled in the study. Among them，63 （34.8%） had asymptomatic new DWI lesions and 2 （1.1%） had symptomatic cerebral infarction. Logistic regression analysis showed carotid plaque hemorrhage （IPH） [subacute phase IPH vs. no IPH：OR：9.393；95% confidence interval （4.431，19.911）] was an independent risk factor for predicting asymptomatic DWI lesions after CAS. Conclusion    Preoperative application of non-enhanced multi-contrast high-resolution magnetic resonance imaging to evaluate plaque components can detect plaque instability and has important potential value for indication of CAS.

Key words: carotid artery stenosis, magnetic resonance imaging, carotid artery stenting, plaque