Application value of multi-slice spiral CT angiography in carotid atherosclerotic plaque in patients with ischemic cerebrovascular disease

doi:10.3969/j.issn.1672-6731.2020.10.008

Abstract

Abstract:

Objective To investigate the value of multi-slice spiral CT angiography (MSCTA) in the evaluation of carotid plaque surface morphology, composition, nature, "napkin ring sign" and carotid remodeling index (RI). Methods A total of 237 patients (390 carotid arteries) with carotid plaque detected by MSCTA from December 2015 to December 2016 were enrolled. They were divided into ischemic event group (136 cases with 212 carotid arteries) and non ischemic event group (101 cases with 178 carotid arteries). Carotid artery stenosis rate was calculated and the degree of stenosis was judged according to North American Symptomatic Carotid Endarterectomy Trial (NASCET). The location of carotid plaque (common carotid artery, bifurcation of common carotid artery and extracranial segment of internal carotid artery), plaque type (fatty plaque, calcified plaque and mixed plaque, ulcerative and non ulcer plaque), carotid RI and "napkin ring sign" were evaluated by post-processing techniques such as volume reconstruction (VR), multiplanar reconstruction (MPR), curved planar reconstruction (CPR) and maximum intensity projection (MIP). Results The proportion of moderate and severe carotid artery stenosis and occlusion in ischemic event group was higher than that in non ischemic event group[44.81% (95/212) vs. 21.91% (39/178); χ²=22.501, P=0.000). A total of 206 carotid plaques were detected in the ischemic event group and 209 in the non ischemic event group, occurred in the bifurcation of the common carotid artery[45.63% (94/206) vs. 47.37% (99/209); χ²=0.136, P=0.934]; in the ischemic event group, mixed plaques which mainly composed of fat[34.95% (72/206) vs. 12.92% (27/209)] and fatty plaques[38.83% (80/206) vs. 23.44% (49/209); χ²=64.749, P=0.000), the proportion of ulcerative plaque[8.74% (18/206) vs. 2.87% (6/209); χ²=6.554, P=0.001] and the positive rate of "napkin ring sign"[12.62% (26/206) vs. 2.87% (6/209); χ²=10.161, P=0.001] were all higher than those in the non ischemic event group. The carotid RI in the ischemic event group was also higher than that in the non ischemic event group (1.13±0.11 vs. 1.04±0.12; t=2.254, P=0.028). Conclusions "Napkin ring sign" can be seen in carotid artery fatty plaques, mixed plaques dominated by fat components, ulcerative plaques and MSCTA, which are more likely to cause clinical cerebral ischemia events. As a noninvasive imaging method in vivo, MSCTA can accurately display and analyze the morphological characteristics and properties of plaque, and has important clinical value in the assessment of plaque vulnerability.

Key words: Stroke, Brain ischemia, Carotid arteries, Plaque,atherosclerotic, Tomography,X-ray computed, Angiography

摘要：

目的探讨多层螺旋CTA（MSCTA）对颈动脉斑块表面形态特征、构成成分、性质、“餐巾环征”和颈动脉重构指数（RI）的评估价值。方法纳入2015年12月至2016年12月经MSCTA检出颈动脉斑块患者共237例计390支颈动脉，其中发生脑缺血事件者136例（212支颈动脉）、未发生脑缺血事件者101例（178支颈动脉），参照北美症状性颈动脉内膜切除术试验计算颈动脉狭窄率并判断狭窄程度，容积再现、多平面重建、曲面重组和最大密度投影重建等后处理技术评价颈动脉斑块部位（颈总动脉、颈总动脉分叉部和颈内动脉颅外段）、斑块类型（脂肪斑块、钙化斑块和混合性斑块，以及溃疡型和非溃疡型斑块）、颈动脉重构指数和“餐巾环征”。结果脑缺血事件组患者颈动脉中度、重度狭窄和闭塞比例高于无脑缺血事件组［44.81%（95/212）对21.91%（39/178）；χ²=22.501，P=0.000］。脑缺血事件组共检出颈动脉斑块206个、无脑缺血事件组检出209个，好发于颈总动脉分叉部［45.63%（94/206）对47.37%（99/209）；χ²=0.136，P=0.934］；脑缺血事件组脂肪斑块［38.83%（80/206）对23.44%（49/209）］和以脂肪成分为主的混合性斑块［34.95%（72/206）对12.92%（27/209）］所占比例（χ²=64.749，P=0.000），溃疡型斑块比例［8.74%（18/206）对2.87%（6/209）；χ²=6.554，P=0.001］，以及“餐巾环征”阳性率［12.62%（26/206）对2.87%（6/209）；χ²=10.161，P=0.001］均高于无脑缺血事件组。脑缺血事件组颈动脉重构指数亦高于无脑缺血事件组（1.13±0.11对1.04±0.12；t=2.254，P=0.028）。结论颈动脉脂肪斑块、以脂肪成分为主的混合性斑块、溃疡型斑块，以及MSCTA所显示的“餐巾环征”，均使临床脑缺血事件发生风险明显增加。MSCTA作为一种在体无创性影像学检查手段，可以准确显示并分析斑块形态特征和性质，对斑块易损性的评估具有重要临床价值。

关键词: 卒中, 脑缺血, 颈动脉, 斑块, 动脉粥样硬化, 体层摄影术, X线计算机, 血管造影术

SHEN Yan-chang, WANG Lin, YIN Xu-hua. Application value of multi-slice spiral CT angiography in carotid atherosclerotic plaque in patients with ischemic cerebrovascular disease[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(10): 886-892.

沈艳昌, 王琳, 殷旭华. 多层螺旋CTA评估缺血性脑血管病患者颈动脉粥样硬化斑块形态特征的价值[J]. 中国现代神经疾病杂志, 2020, 20(10): 886-892.

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