J Cardiovasc Magn Reson:利用高分辨率心血管磁共振识别颅内动脉夹层的高危临床和影像学特征

2021-06-19 MedSci原创 MedSci原创

hrCMRI有助于IAD的可视化和表征,与DSA相比,对IAD的诊断具有重要的互补价值。

颅内动脉夹层(Intracranial artery dissection, IAD)是颅内动脉壁因层裂而产生的血肿。与颅外动脉夹层不同,IAD多引起血栓栓塞,常因血流动力学损伤引起头痛和脑血管缺血事件。IAD仅占所有缺血性中风的一小部分(1-2%)。然而,它是青年和中年人中风的一个重要原因(10-20%),特别是在亚洲人口中。诊断是具有挑战性的,因为成像特征可能很难检测,因为它们尺寸小、复杂。因此,经常需要多模态成像来确认诊断。

最近,J Cardiovasc Magn Reson杂志发表文章,旨在通过高分辨率心血管磁共振成像(hrCMR)来表征IAD,并量化hrCMR在识别高风险病变方面的增量价值。

收集神经症状发生后30天内进行介入检查或采用数字减影血管造影(DSA)和采用3T CMR系统的hrCMR患者的影像资料。CMR方案包括扩散加权成像(DWI),黑血T1-,T2-和T1加权对比增强序列。根据影像学表现和患者临床表现将病变分为culprit和非culprit IAD。

采用单因素和多因素分析评估culprit和非culprit IAD之间的差异,以及hrCMR在识别更高风险病变方面的互补价值。

具有代表性的颅内动脉夹层(intracranial artery dissection, IAD)高分辨率心血管磁共振(hrCMR)图像具有不同的形态学和组成特征

考虑脑DWI及解剖远端分支供血血管区域的相关位置,将每个检测到的夹层独立划分为culprit和非culprit IAD。DWI信号正常的解剖血管,以及无感觉或运动障碍、短暂性脑缺血发作或缺血性中风等经典脑血管症状的患者被认为是非culprit IAD。同时,将每一种解剖分为五种不同的类型(I型:经典解剖;II型:梭状动脉瘤;III型:长夹层动脉瘤;IV型:巨大动脉瘤;V型:囊性动脉瘤),与以往的研究和共识一致。

区分culprit和非culprit IAD病变的不同特征和参数的功效。a四个下曲线表示每个独立参数识别culprit IAD的诊断性能;b四个高曲线显示了结合传统特征(年龄和高血压)和DSA伴或不伴hrCMR特征(血肿)来区分culprit夹层与非culprit夹层的诊断性能,融合传统特征和hrCMR特征的ROC曲线下面积(AUC)值最高为融合传统特征和hrCMR特征的ROC曲线下面积(0.940)高于DSA + hrCMR的ROC曲线下面积(0.918)。

该研究共纳入75例患者。根据病变形态可分为5种类型:I型、经典夹层(n = 50);II型,梭状动脉瘤(n = 1);III型,长夹层动脉瘤(n = 3);IV型为长延性夹层动脉瘤9例,V型为囊性动脉瘤12例。回归分析显示,年龄和高血压都与culprit病变相关(年龄:OR, 0.83;95%可信区间0.75 - -0.92;p<0.001,高血压:OR, 66.62;95%可信区间5.91 - -751.11;p=0.001)。hrCMR发现的血肿与culprit病变显著相关(OR, 16.80;95%可信区间1.01 - -280.81;p=0.037)。其中17例(16个病变被判定为culprit)被诊断为IAD,但DSA未见,15例为I型病变。

分析发现,根据hrCMR的形态学特征,IAD可分为5种不同类型。hrCMR显示年龄、高血压、血肿可有效区分culprit和非culprit病变。此外,与合并传统危险因素相比,结合传统危险特征和hrCMR特征(血肿)时,ROC曲线显著升高。该研究表明,与传统的危险因素相比,hrCMR在识别culprit IAD方面的价值显著增加,特别是对于那些无法使用DSA诊断的因素。

综上所述,hrCMRI有助于IAD的可视化和表征,与DSA相比,对IAD的诊断具有重要的互补价值。

原文出处

Shi, Z., Tian, X., Tian, B. et al. Identification of high risk clinical and imaging features for intracranial artery dissection using high-resolution cardiovascular magnetic resonance. J Cardiovasc Magn Reson 23, 74 (2021). https://doi.org/10.1186/s12968-021-00766-9

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    2021-06-29 lsndxfj
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    2022-06-02 quxin068
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    2021-06-21 hongbochen
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    2021-06-19 仁术2021

    学习了

    0

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