CT能谱成像对颈动脉斑块成分的评估价值及对缺血性脑卒中预防的指导作用-现代医学

CT能谱成像对颈动脉斑块成分的评估价值及对缺血性脑卒中预防的指导作用

单位：1. 三亚市人民医院放射科, 海南三亚 572000;
2. 中山医科大学附属第一医院放射科, 广东广州 510080

分类号：R743.3;R814.42

出版年·卷·期（页码）：2018·46·第六期（651-656）

摘要：

目的：应用能谱CT动脉成像（CTA）分析颈动脉斑块成分，探讨CTA征象与缺血性脑卒中（IS）的关系及对IS预防的指导作用。方法：回顾性分析2015年1月至2017年1月120例IS患者（研究组）的CTA影像资料，并与120例非IS患者（对照组）的CTA影像资料进行对比，分析CTA在诊断颈动脉斑块成分中的价值，所有患者随访1年，多元逻辑回归分析评估颈动脉斑块的影像学特征与终点事件的相关性。结果：共检出颈动脉斑块124块，研究组检出率95.83%（115/120），显著高于对照组的7.50%（9/120）（χ²=9.167，P=0.002），研究组稳定斑块与不稳定斑块比例为1.09：1，而对照组比例为8：1，两组斑块稳定性对比差异有统计学意义（χ²=5.825 1，P<0.05）；研究组颈动脉狭窄发生率为43.48%，对照组为11.11%，两组比较差异具有统计学意义（χ²=5.054 2，P<0.05）；不同性质斑块在CTA能谱曲线图上有显著的差异，脂肪成分斑块能谱曲线图呈弓背向上，纤维、内部出血型斑块能谱曲线图随着能量增高CT值逐渐降低，纤维斑块降幅大于出血型斑块；缺血性脑卒中复发重要的预测因素为脂质斑块，随访期出现终点事件的可能性与脂质核心大小相关联，脂质核心越大则终点事件出现概率越大（OR=1.26，P<0.01）。结论：CT能谱成像在诊断颈动脉斑块成分中有较高的价值，可以用于远期卒中事件风险的预测，为IS患者建立二级预防机制。

Objective:To analyze carotid plaque composition by using CT angiography (CT angiography, CTA),and to explore the relationship between CTA signs and ischemic stroke (IS) and its guiding role in the prevention of IS patients. Methods:The data of 120 patients with IS(observation group) from January 2015 to January 2017 were analyzed retrospectively, and CTA images of 120 non-IS patients(control group) were included. The value of CTA in the diagnosis of carotid plaque was analyzed.All patients were interviewed for 1 year, and the correlation between the imaging features of carotid plaque and endpoint events was evaluated by multiple logistic regression analysis. Results:124 carotid plaques were detected. The detectable rate of carotid plaque in the observation group was 95.83%, which was significantly higher than that in the control group (7.5%, χ²=9.167,P=0.002). The ratio of stable plaque to unstable plaque was 1.09:1 in the observation group,and 8:1 in the control group. There was a significant difference in plaque stability between the two groups (P<0.05). Thecarotid stenosis rate in the two groups were 43.48% and 11.11%, it was higher in the observation group(χ²=5.054 2,P<0.05). There were significant differences in CTA curve between different plaques. The spectrum curves of fatty plaques showed a bow up and fibers and internal blood group plaques decreased gradually with the increase of energy CT, and the decrease of fiber was greater than that of blood type plaques. An important predictor of ischemic stroke recurrence was lipid plaque. The probability of terminal events in follow-up was associated with the size of lipid core. The larger the lipid core, the greater the probability of occurrence of terminal events (OR=1.26, P<0.01)Conclusion:CT energy spectrum imaging has high value in the diagnosis of carotid plaque composition, it can be used for long-term prediction of stroke risk and establish a two level prevention mechanism for IS patients.

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