現：3DT1加權梯度回波（3DT1GRE）序列有助CAS相關腦栓塞的預測
預防腦栓塞是頸動脈支架（CAS）的一個重要問題。為此，日本Mie醫學研究生院神經外科的HiroshiTanemura博士等人進行了一項研究，研究結果于2012年11月20日在線發表在Stroke雜志上。研究結果發現：3DT1加權梯度回波（3DT1GRE）序列有助CAS相關腦栓塞的預測。
研究人員使用3DT1GRE圖像測量信號密度比值（SIR）和斑塊容積，并對CAS前的47個頸動脈斑塊特性進行量化分析。我們使用T1加權渦輪場回波序列獲得3DT1GRE圖像。研究人員也在CAS前后評估腦彌散加權圖像（DWI）以檢測腦血栓所致的缺血病灶（DWI病灶）。
研究結果發現：存在DWI病灶組（P組：n=26）相較沒有DWI病灶組（N組：n=21）：SIR(2.17[四分位1.50–3.07]對比1.35[四分位1.08–1.97];P=0.010)和斑塊容積(456mm3[四分位256–696]對比301mm3[四分位：126–433];P=0.008)顯著增高。根據多變量對數回歸分析，SIR(P=0.007)和斑塊容量(P=0.042)是CAS相關DWI病灶的獨立預測因素。而且，SIR(rs=0.42,P=0.005)和斑塊容量(rs=0.36,P=0.012)與DWI病灶數量正相關。根據受試者工作特性曲線分析發現：SIR和斑塊容量預測CAS相關DWI病灶的最佳切線值分別為1.80和373mm3。
該研究發現：使用3DT1GRE圖像對頸動脈斑塊進行量化分析，有利于預測CAS相關的腦栓塞。
DOI:10.1161/STROKEAHA.112.663138
PMC:
PMID:
High-Risk Plaque for Carotid Artery Stenting Evaluated With 3-Dimensional T1-Weighted Gradient Echo Sequence
Hiroshi Tanemura, Masayuki Maeda, Naoki Ichikawa, Yoichi Miura, Yasuyuki
Umeda, Seiji Hatazaki, Naoki Toma, Fumio Asakura, Hidenori Suzuki,
Hiroshi Sakaida, Satoshi Matsushima, and Waro Taki
BACKGROUND AND PURPOSE: Preventing cerebral embolisms is a major concern
with carotid artery stenting (CAS). This study evaluated 3-dimensional
T1-weighted gradient echo (3D T1GRE) sequence to predict cerebral
embolism related to CAS. METHODS: We performed quantitative analyses of
the characteristics of 47 carotid plaques before CAS by measuring the
signal intensity ratio (SIR) and plaque volume using 3D T1GRE images. We
used T1-weighted turbo field echo sequence to obtain 3D T1GRE images.
We also evaluated diffusion-weighted images (DWI) of the brain before
and after CAS to detect ischemic lesions (DWI lesions) from cerebral
emboli. RESULTS: SIR (2.17 [interquartile range 1.50-3.07] versus 1.35
[interquartile range 1.08-1.97]; P=0.010) and plaque volume (456 mm(3)
[interquartile range 256-696] versus 301 mm(3) [interquartile range
126-433]; P=0.008) were significantly higher in the group of patients
positive for DWI lesions (P-group: n=26) than DWI lesion-negative
patients (N-group: n=21). In multivariate logistic regression analysis,
SIR (P=0.007) and plaque volume (P=0.042) were independent predictors of
DWI lesions with CAS. Furthermore, SIR (rs=0.42, P=0.005) and plaque
volume (rs=0.36, P=0.012) were positively correlated with the number of
DWI lesions. From analysis of a receiver-operating characteristic curve,
the most reliable cutoff values of SIR and plaque volume to predict DWI
lesions related to CAS were 1.80 and 373 mm(3), respectively.
CONCLUSIONS: Quantitative evaluation of carotid plaques using 3D T1GRE
images may be useful in predicting cerebral embolism related to CAS.