預(yù)防腦栓塞是頸動(dòng)脈支架（CAS）的一個(gè)重要問題。為此，日本Mie醫(yī)學(xué)研究生院神經(jīng)外科的HiroshiTanemura博士等人進(jìn)行了一項(xiàng)研究，研究結(jié)果于2012年11月20日在線發(fā)表在Stroke雜志上。研究結(jié)果發(fā)現(xiàn)：3DT1加權(quán)梯度回波（3DT1GRE）序列有助CAS相關(guān)腦栓塞的預(yù)測(cè)。

　　研究人員使用3DT1GRE圖像測(cè)量信號(hào)密度比值（SIR）和斑塊容積，并對(duì)CAS前的47個(gè)頸動(dòng)脈斑塊特性進(jìn)行量化分析。我們使用T1加權(quán)渦輪場(chǎng)回波序列獲得3DT1GRE圖像。研究人員也在CAS前后評(píng)估腦彌散加權(quán)圖像（DWI）以檢測(cè)腦血栓所致的缺血病灶（DWI病灶）。

　　研究結(jié)果發(fā)現(xiàn)：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(duì)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(duì)比301mm3[四分位：126–433];P=0.008)顯著增高。根據(jù)多變量對(duì)數(shù)回歸分析，SIR(P=0.007)和斑塊容量(P=0.042)是CAS相關(guān)DWI病灶的獨(dú)立預(yù)測(cè)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(shù)量正相關(guān)。根據(jù)受試者工作特性曲線分析發(fā)現(xiàn)：SIR和斑塊容量預(yù)測(cè)CAS相關(guān)DWI病灶的最佳切線值分別為1.80和373mm3。

　　該研究發(fā)現(xiàn)：使用3DT1GRE圖像對(duì)頸動(dòng)脈斑塊進(jìn)行量化分析，有利于預(yù)測(cè)CAS相關(guān)的腦栓塞。
 

　　DOI:10.1161/STROKEAHA.112.663138

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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.