（承德医学院附属医院血管疝外科；河北承德067000）
【摘要】目的；采用磁共振黑血技术评价颈动脉狭窄和斑块稳定性，并依据狭窄程度及斑块的稳定性，给颈动脉支架置入或者颈动脉内膜剥脱手术提供参考。方法；选取我院2018年5月到2019年7月期间住院的50例颈动脉狭窄患者，对该50例患者行磁共振黑血技术测得的颈动脉狭窄程度与金标准DSA比较，将24例颈动脉内膜切除术的病理资料与术前行核磁黑血技术的结果进行比较，来评估磁共振黑血技术对颈动脉狭窄和斑块稳定性的诊断价值。结果；共采取56支不同程度狭窄的颈动脉，其中24例行颈动脉内膜切除术。共获得24块斑块标本，磁共振黑血技术显示；轻度狭窄13支，中度狭窄23支，重度狭窄18支，完全闭塞2支，纤维帽信号19支，脂质核心15支，斑块内出血12支，钙化13支;DSA显示：轻度狭窄13支，中度狭窄25支，重度狭窄17支，完全闭塞1支；病理结果显示：21个斑块显示纤维帽结构，18个具有脂质核心，13个斑块具有出血，15个斑块具有钙化。结论；通过将磁共振黑血技术用于诊断颈动脉狭窄和判断斑块稳定性，不仅可以准确评估颈动脉狭窄程度，还可以很好地判断斑块的稳定性，值得在临床实践中不断采用和推广。
【关键词】磁共振黑血技术；颈动脉狭窄；粥样硬化斑块；DSA
【Abstract】Objective: To evaluate the evaluation of carotid stenosis and the evaluation of plaque stability by magnetic resonance black blood technique, and to place carotid artery stent or carotid endarterectomy according to the degree of stenosis and the stability of plaque. The surgery provides a reference. Methods: 50 patients with carotid stenosis admitted to our hospital from May 2018 to July 2019 were enrolled. The degree of carotid stenosis measured by magnetic resonance black blood technique in 50 patients was compared with the gold standard DSA. The pathological data of 24 cases of carotid endarterectomy were compared with the results of preoperative nuclear magnetic black blood technique. The value of magnetic resonance black blood technique for carotid stenosis and plaque properties was evaluated. Results: A total of 56 carotid arteries with different degrees of stenosis were taken. Among them, 24 patients underwent carotid endarterectomy. A total of 24 plaque specimens were obtained. Magnetic resonance black blood technique showed 13 cases with mild stenosis and moderate stenosis. 23, severe stenosis 18, complete occlusion 2, 19 with fibrous cap signal, 15 with lipid core, 12 with plaque, 13 with calcification; DSA showed: 13 with mild stenosis The degree was narrow and 25, severe stenosis was 17 and completely occluded. The pathological results showed that 21 plaques showed fibrous cap structure, 18 had lipid cores, 13 plaques had hemorrhage, and 15 plaques had calcification. Conclusion: The application of magnetic resonance black blood technique in the diagnosis of carotid stenosis and plaque nature can not only accurately assess the degree of carotid stenosis, but also can well determine the stability of plaque. It is worthy of continuous adoption in clinical practice.
[Key words] magnetic resonance black blood technique; carotid artery stenosis; atherosclerotic plaque; DSA
脑血管病是当今世界上发病率与死亡率最高的三大疾病之一，其中缺血性脑血管病占脑卒中的80%[[[] Bamford J, Dennis M, Sandercock P, et al. The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project.[J]. Journal of Neurology Neurosurgery & Psychiatry, 1990, 53(10):824-9.]]。颈动脉粥样硬化斑块是缺血性脑血管疾病重要的危险因素，颈动脉斑块稳定性越差、颈动脉狭窄程度越严重[[[] 周丽丹[1], 刘恒方[1], 徐红卫[1], et al. 磁共振黑血技术及MSCTA对颈动脉斑块特征的研究[J]. 中国实用神经疾病杂志, 2013, 16(2):10-12.]-[[] 陈瑞英, 郑清存, 安雅臣,等. 脂蛋白相关性磷脂酶A2、超敏C反应蛋白与脑梗死患者颈动脉粥样硬化斑块的关系[J]. 中国实验诊断学, 2011, 15(7):1122-1124.]]。目前，颈动脉狭窄病变的临床评价主要有超声，脑血管造影和磁共振血管造影等成像方法，而磁共振黑血技术判断颈动脉狭窄时能够显示出纤维帽与脂质核心的厚度，这对斑块稳定性的评估有较强的的诊断价值[[[] Cappendijk V C , Cleutjens K B J M , Kessels A G H , et al. Assessment of Human Atherosclerotic Carotid Plaque Components with Multisequence MR Imaging: Initial Experience1[J]. Radiology, 2005, 234(2):487-492.
[5] Takaya N , Yuan C , Chu B . Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: A prospective assessment with MRI—initial results[J]. Journal of Vascular Surgery, 2006, 43(5):1077.
[6] Yuan, C. Identification of Fibrous Cap Rupture With Magnetic Resonance Imaging Is Highly Associated With Recent Transient Ischemic Attack or Stroke[J]. Circulation, 2002, 105(2):181-185.
[7] KERWIN, William S , O'BRIENN, et al. Inflammation in carotid atherosclerotic plaque : A dynamic contrast-enhanced mr imaging study[J]. Radiology, 2006, 241(2):459.
[8] Underhill H R , Yuan C , Zhao X Q , et al. Effect of rosuvastatin therapy on carotid plaque morphology and composition in moderately hypercholesterolemic patients: A high-resolution magnetic resonance imaging trial[J]. American Heart Journal, 2008, 155(3):0-2147483647.
[9] Phan B A P , Chu B , Polissar N , et al. Association of high-density lipoprotein levels and carotid atherosclerotic plaque characteristics by magnetic resonance imaging[J]. The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging), 2007, 23(3):337-342.
]-9]。本文主要分析磁共振黑血技术对颈动脉狭窄和斑块特征的诊断，如下所述。
1.资料与方法
1.1一般资料
收集2018年5月至2019年7月在承德医学院附属医院住院，明确诊断为颈动脉狭窄并且做过DSA检查及磁共振黑血技术的患者的影像学资料及部分行手术治疗的患者的病理学资料。其中24例行颈动脉内膜切除术（CEA），26例行颈动脉支架置入术（CAS）。在50名患者中，40名男性，10名女性，年龄60-80岁，受试者的年龄，性别和危险因素如高血压，糖尿病，高脂血症，吸烟和饮酒没有显著差异。
1.2方法
磁共振黑血检查序列包括：PHILIPS Achieva 3.0T MR扫描仪，颈动脉专用线圈。扫描序列：T1WI，T2WI。
DSA检查方法：应用SIEMENS AXIONM dTA血管造影机进行血管造影检查，嘱患者平卧，充分暴露双侧腹股沟区，常规消毒铺巾，2%利多卡因局部麻醉，采用sledinger技术穿刺股动脉，置入5F导管鞘，经导管鞘在导丝导引下送入5F猪尾巴管造影主动脉弓，采集颈动脉造影图像，若发现有颈动脉狭窄，计算狭窄率。
在CEA中剥脱下的斑块行HE染色，来观察斑块的纤维帽、脂质池、坏死核心、钙化、出血等成分组成。
统计分析： 采用SPASS17.0统计软件包进行统计学分析，对磁共振黑血技术和DSA两种监测方法的真实性和可靠性（Kappa）进行统计学分析；计量资料采用卡方检验和确切概率法计算P值（n<40）,检验水准为p=0.05。
2结果
.png)
.png)
.png)
.png)
3讨论
在这项研究中，我们发现磁共振黑血技术和金标准“DSA”在颈动脉狭窄的诊断中具有良好的一致性。同时，磁共振黑血技术可以显示斑块中的成分，与病理结果没有统计学上的显著差异。磁共振黑血技术作为近年来的新技术，对于监测斑块成分有较强的优势，逐渐成为颈动脉斑块诊断最有效的方法，它无创性地判断斑块的稳定性，为选择颈动脉内膜剥脱或者支架植入确定手术时机提供参考，值得在临床上推广应用。
参考文献
[] Bamford J, Dennis M, Sandercock P, et al. The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project.[J]. Journal of Neurology Neurosurgery & Psychiatry, 1990, 53(10):824-9.
[] 周丽丹[1], 刘恒方[1], 徐红卫[1], et al. 磁共振黑血技术及MSCTA对颈动脉斑块特征的研究[J]. 中国实用神经疾病杂志, 2013, 16(2):10-12.
[] 陈瑞英, 郑清存, 安雅臣,等. 脂蛋白相关性磷脂酶A2、超敏C反应蛋白与脑梗死患者颈动脉粥样硬化斑块的关系[J]. 中国实验诊断学, 2011, 15(7):1122-1124.
[] Cappendijk V C , Cleutjens K B J M , Kessels A G H , et al. Assessment of Human Atherosclerotic Carotid Plaque Components with Multisequence MR Imaging: Initial Experience1[J]. Radiology, 2005, 234(2):487-492.
[5] Takaya N , Yuan C , Chu B . Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: A prospective assessment with MRI—initial results[J]. Journal of Vascular Surgery, 2006, 43(5):1077.
[6] Yuan, C. Identification of Fibrous Cap Rupture With Magnetic Resonance Imaging Is Highly Associated With Recent Transient Ischemic Attack or Stroke[J]. Circulation, 2002, 105(2):181-185.
[7] KERWIN, William S , O'BRIENN, et al. Inflammation in carotid atherosclerotic plaque : A dynamic contrast-enhanced mr imaging study[J]. Radiology, 2006, 241(2):459.
[8] Underhill H R , Yuan C , Zhao X Q , et al. Effect of rosuvastatin therapy on carotid plaque morphology and composition in moderately hypercholesterolemic patients: A high-resolution magnetic resonance imaging trial[J]. American Heart Journal, 2008, 155(3):0-2147483647.
[9] Phan B A P , Chu B , Polissar N , et al. Association of high-density lipoprotein levels and carotid atherosclerotic plaque characteristics by magnetic resonance imaging[J]. The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging), 2007, 23(3):337-342.
论文作者:吕震,张弘通信作者,吴忠隐,马涛
论文发表刊物:《医师在线》2019年10月20期
论文发表时间:2020/1/6
标签：磁共振论文; 狭窄论文; 颈动脉论文; 技术论文; 造影论文; 稳定性论文; 内膜论文; 《医师在线》2019年10月20期论文;