上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (07): 901-907.doi: 10.3969/j.issn.1674-8115.2020.07.007

• 论著·临床研究 • 上一篇    下一篇

术前颈动脉斑块动态增强磁共振成像对支架置入后再狭窄发生的预测价值

葛晓乾1，李 晓2，赵辉林2，孙贝贝2，许建荣2，刘晓晟2   

  1. 1. 山东省立医院西院影像科，济南 250022；2.上海交通大学医学院附属仁济医院放射科，上海 200127
  • 出版日期:2020-07-28 发布日期:2020-09-23
  • 通讯作者: 刘晓晟，电子信箱：18918662866@163.com。
  • 作者简介:葛晓乾（1991—），女，住院医师，硕士生；电子信箱：gexiaoqian1123@163.com。
  • 基金资助:
    国家自然科学基金（81801650，81571630）；上海市卫生健康委员会科研课题（201940060）；上海交通大学医学院附属仁济医院南院博士专项（2019NYBSZX01）。

Predictive value of dynamic contrast-enhanced MRI of original plaque on carotid artery in-stent restenosis

GE Xiao-qian1, LI Xiao2, ZHAO Hui-lin2, SUN Bei-bei2, XU Jian-rong2, LIU Xiao-sheng2   

  1. 1. Department of Medical Imaging, Shandong Provincial Western Hospital, Jinan 250022, China; 2. Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2020-07-28 Published:2020-09-23
  • Supported by:
    National Natural Science Foundation of China (81801650, 81571630); Shanghai Municipal Health Commission (201940060); Renji Southern Hospital PHD Program (2019NYBSZX01).

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摘要： 目的·探索颈动脉支架置入术前动态增强磁共振成像（dynamic contrast-enhanced MR imaging，DCE-MRI）预测术后支架内再狭窄发生的价值。方法·选取40例拟行颈动脉支架置入术的颈动脉粥样硬化斑块患者病例资料进行前瞻性分析。在术前1周内完成颈动脉血管壁磁共振成像（vessel wall MR imaging，VW-MRI）及DCE-MRI成像，应用颈动脉造影检查判断患者在术后第6个月是否发生再狭窄。评估DCE-MRI与支架内再狭窄的相关性。结果·再狭窄患者组Ktrans和vP显著高于无再狭窄组（P=0.000，P=0.037），Ktrans可独立预测支架内再狭窄（OR=1.43，95%CI 1.17～1.56，P=0.012），最佳阈值为0.09 min-1（敏感度为100%，特异度为87.5%）。结论·斑块内的炎症活动可能引起支架置入后的内膜过度增生；Ktrans可独立预测颈动脉支架术后再狭窄的发生，有望成为预测支架内再狭窄发生的有效手段。

关键词: 动态增强磁共振成像, 颈动脉, 动脉粥样硬化, 支架内再狭窄

Abstract:

Objective · To explore the value of dynamic contrast-enhanced MR imaging (DCE-MRI) of original plaque to predict carotid artery in-stent restenosis (ISR). Methods · Forty cases of the patients with carotid atherosclerosis who were to undergo the carotid artery stenting (CAS) were included in this study. All participants underwent vessel wall MR imaging (VW-MRI) and DCE-MRI within one week before CAS. Carotid digital subtraction angiography (DSA) were performed at the sixth month to reassess the stenosis of stent. The correlation between DCE-MRI and ISR was evaluated. Results · The level of Ktran in ISR group was significantly higher than that in non-ISR group (P=0.000), and so was the vP (P=0.037). Ktrans could independently predict ISR (OR=1.43, 95%CI 1.17-1.56, P=0.012), and the cut-off value of Ktrans was 0.09 min-1 (sensitivity=100%, specificity=87.5%). Conclusion · Intraplaque inflammation may lead to excessive intimal hyperplasia after ISR. Ktrans could be a risk predictor of ISR with high sensitivity and specificity. DCE-MRI could be an effective tool to predict ISR.

Key words: dynamic contrast-enhanced MR imaging (DCE-MRI), carotid artery, atherosclerosis, in-stent restenosis

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