摘要
目的：评估缺血性卒中患者颅内供血动脉硬化斑块的强化特征，分析责任血管斑块强化程度与时间推移及血清超敏C-反应蛋白（ hs-CRP）浓度的相关性。方法回顾性分析2010年3月至2013年4月来院住院缺血性卒中患者81例颅内责任血管的管壁特征。所有患者均进行3.0 T MR常规卒中方案扫描及斑块高分辨率MRI（ HR-MRI）。根据卒中症状发生至HR-MRI检查间隔，分为早期组58例（间隔＜4周）、中期组13例（间隔为4～12周）、晚期组10例（间隔＞12周）。分析责任血管的管壁特征、斑块强化程度，测量血清hs-CRP的浓度。采用多组秩和检验（ Kruskal-Wallis H检验）比较3组间斑块强化程度及血清hs-CRP差别，血清hs-CRP浓度以中位数（上下四分位数）表示；采用Spearman等级相关分析症状发生后时间及hs-CRP与强化程度之间的关系。结果81例患者中，55例硬化性斑块位于大脑中动脉M1段，26例位于基底动脉。早期组斑块明显强化29例、轻度强化25例、未见强化4例；中期组对应的例数分别为4、6、3例；晚期组对应的例数分别为0、4、6例；3组间斑块强化程度之间的差别具有统计学意义（H＝16.934，P＜0.01）。随着时间的推移，强化的发生率及程度减低，二者呈明显负相关关系（ r＝-0.792， P ＜0.01）。早期、中期及晚期3组患者血清hs-CRP浓度分别为7.0（3.0，13.0）、2.3（1.0，3.0）及1.9（0.5，4.0）mg/L，3组间差别具有统计学意义（ H＝14.345， P ＜0.01）。血清 hs-CRP 浓度随时间的推移呈递减趋势，二者呈负相关（ r ＝-0.357，P＜0.01），与斑块强化程度呈正相关关系（r＝0.526，P＜0.01）。结论 HR-MRI增强扫描能清晰显示颅内动脉硬化斑块的强化，可作为颅内动脉硬化斑块炎症反应的标志，对斑块破裂及继发的缺血性脑卒中风险评估具有重要价值。
Objective To assess the enhancement feature of intracranial atherosclerotic plaque in the vessel supplying the territory of infarction by using high-resolution MR imaging.To analyze the correlation between the degree of plaque enhancement , time elapsed and the concentration of hypersensitive C-reactive protein （ hs-CRP ）.Methods The characteristics of vessel walls and intracranial vascular stenoses were retrospectively analyzed in 81 patients with ischemic strokes.All subjects were imaged with a traditional stroke MR protocol and HR-MRI scanning for plaque on a 3.0 T MRI scanner.According to the elapsed time between infarct and MR examination , all cases were classified into early stage （12 weeks, n=10）.The characteristics of vessel walls and degrees of enhancement of atherosclerotic plaques were assessed and the concentrations of hs-CRP in all patients were determined.The Kruskal-Wallis H test was used to compare the degree of enhancement and hs-CRP concentration among the early , middle and late stage.The concentration＆nbsp;of hs-CRP was presented as median （ interquartile range ）.The Spearman correlation was used to analyze the correlation between elapsed time , hs-CRP concentration and degree of enhancement.Results Fifty-five （55/81） plaques were located at the M1 segments, and the other 26 （26/81） plaques were at the basilar artery.The degree and presence of enhancement from strong to none were 29, 25 and 4 in the early stage;4, 6 and 3 in the middle stage and 0, 4, 6 in the late stage, respectively.The degree and presence of enhancement were significantly different among them （H=16.934,P〈0.01）.There was a remarkable trend of decreasing degree and presence of enhancement of the atherosclerotic plaque relative to increasing time after the ischemic event（r=-0.792,P〈0.01）.The serum hs-CRP concentration for early, middle and late stage were 7.0（3.0, 13.0）, 2.27（1.0, 3.03） and 1.88（0.50, 4.0）mg/L （H=14.345,P〈0.01） , respectively.There was a trend of decreasing hs-CRP concentration relative to the time elapsed （ r =-0.357,P〈0.01）.The degrees of enhancement of the plaques were parallel to the levels of hs -CRP（ r=0.526,P〈0.01）.Conclusions Enhanced HR-MRI scanning may clearly demonstrate the enhancement characteristics of intracranial atherosclerotic plaques as an indicator of inflammation.It might play an important role to detect risk factors for intracranial plaque rupture and subsequent acute ischemic stroke .
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2014年第6期462-466,共5页
Chinese Journal of Radiology
基金
国家科技部“十二五”科技支撑计划资助项目（2011BAI08B10）；广东省医学科研基金资助项目
关键词
卒中
磁共振成像
动脉粥样硬化
炎症
Stroke
Magnetic resonance imaging
Atherosclerosis
Inflammation
