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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Identification of the Distal End of Carotid Plaque Using 3-Dimensional Fast Spin Echo T1-Weighted Magnetic Resonance Plaque Imaging
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Identification of the Distal End of Carotid Plaque Using 3-Dimensional Fast Spin Echo T1-Weighted Magnetic Resonance Plaque Imaging

机译：使用三维快速旋转回波T1加权磁共振斑块成像鉴定颈动脉斑块的远端

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Background: Complete removal of the distal end of the plaque is an important requirement in carotid endarterectomy (CEA) to avoid postoperative complication. Preoperative identification of the distal end of plaque contributes to complete plaque removal. Three-dimensional (3D) magnetic resonance (MR) plaque imaging has been widely used to evaluate carotid plaque characterization. The purpose of the present study was to determine whether preoperative 3D fast spin echo (FSE) T1-weighted MR plaque imaging could identify the distal end of carotid plaque. Methods: This study was designed as a prospective cohort study. We examined 50 patients with cervical internal carotid artery (ICA) stenosis who underwent CEA. 3D-FSE T1-weighted MR plaque imaging of the affected carotid bifurcation was preoperatively performed using a 1.5-T scanner. Identification of the distal end of plaque (DEMRI) on MR plaque imaging was performed and the distance from the baseline (Distance(MRI)) was measured. Intraoperatively, the superimposed distal end of carotid plaque (E-sim) was marked on the ICA according to the measurement on MR plaque imaging. The actual distal end of plaque (DECEA) was then identified after arteriotomy and the difference (Difference(C)(EA)(-MRI)) between E-sim and DECEA was measured. Contrast ratio of carotid plaque and tortuosity of the ICA were calculated using MR plaque imaging. Results: Interobserver agreements in measurement of Distance(MRI) were excellent (intraclass correlation coefficient, .955; 95% confidence interval, .922-.974). In 28 patients (56%), E-sim was identical to DECEA. Mean Difference(C)(EA)(-MRI) was 1.32 +/- 1.77 mm. Difference(C)(EA)(-MRI) was significantly greater with fibrotic plaque (4.14 +/- 1.21 mm) than with lipid-rich or necrotic plaque (.43 +/- .87 mm; P < .05) or hemorrhagic plaque (1.27 +/- 1.64 mm; P < .05). Mean Difference(C)(EA)(-MRI) was significantly greater in the group with tortuosity of the ICA less than 120 degrees (3.86 +/- 1.77 mm) than in the group with greater than or equal to 120 degrees but less than or equal to 150 degrees (1.15 +/- 1.51 mm; P < .05) or greater than150 degrees (0.50 +/- 1.10 mm; P < .05). No patients showed residual stenosis after surgery on postoperative MR angiography. Conclusions: Using 3D-FSE T1-weighted MR plaque imaging allowed identification of the distal end of carotid plaque and contributed to complete removal of the plaque, although it may be reduced for cases with low-signal-intensity plaque or severe tortuosity of the ICA.
机译：背景：完全清除斑块远端是颈动脉内膜切除术（CEA）避免术后并发症的重要要求。术前确定斑块远端有助于完全清除斑块。三维（3D）磁共振（MR）斑块成像已广泛用于评估颈动脉斑块特征。本研究的目的是确定术前3D快速自旋回波（FSE）T1加权磁共振斑块成像能否识别颈动脉斑块的远端。方法：本研究为前瞻性队列研究。我们检查了50例接受CEA治疗的颈内动脉（ICA）狭窄患者。术前使用1.5T扫描仪对受影响的颈动脉分叉进行3D-FSE T1加权磁共振斑块成像。在磁共振斑块成像上识别斑块远端（DEMRI），并测量与基线的距离（距离（MRI））。术中，根据磁共振斑块成像的测量结果，在ICA上标记叠加的颈动脉斑块远端（E-sim）。然后在动脉切开术后确定斑块的实际远端（DECEA），并测量E-sim和DECEA之间的差异（差异（C）（EA）（-MRI））。利用磁共振斑块成像计算颈动脉斑块的对比度和颈内动脉的弯曲度。结果：观察者之间在距离测量（MRI）方面的一致性非常好（组内相关系数为0.955；95%可信区间为0.922-0.974）。在28名患者（56%）中，E-sim与DECEA相同。平均差值（C）（EA）（-MRI）为1.32+/-1.77 mm。纤维化斑块（4.14+/-1.21 mm）的差异（C）（EA）（-MRI）显著大于富含脂质或坏死斑块（43+/-0.87 mm；P<0.05）或出血斑块（1.27+/-1.64 mm；P<0.05）。ICA弯曲度小于120度（3.86+/-1.77 mm）组的平均差异（C）（EA）（-MRI）显著大于大于大于或等于120度但小于或等于150度（1.15+/-1.51 mm；P<0.05）或大于150度（0.50+/-1.10 mm；P<0.05）组。术后磁共振血管成像显示术后无残余狭窄。结论：使用3D-FSE T1加权磁共振斑块成像可以识别颈动脉斑块的远端，并有助于完全清除斑块，尽管对于低信号强度斑块或ICA严重扭曲的患者，这种情况可能会减少。

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