| 姬智艳,刘德祥,陈显杰,贺雪萍,向之明.能谱CTA分析颈动脉斑块成分及其与脑梗死的关系[J].中国医学影像技术,2020,36(9):1309~1313 |
| 能谱CTA分析颈动脉斑块成分及其与脑梗死的关系 |
| Analysis of the components of carotid plaque and relationship with cerebral infarction with spectral CTA |
| 投稿时间：2019-08-08 修订日期：2020-01-17 |
| DOI：10.13929/j.issn.1003-3289.2020.09.008 |
| 中文关键词: 斑块 脑梗死 体层摄影术,X线计算机 血管造影术 |
| 英文关键词:plaque cerebral infarction tomography, X-ray computer angiography |
| 基金项目:广东省自然科学基金项目（2015A030313753）、广州市民生科技攻关计划项目（201903010032）、广州市番禺区科技计划项目（2017-Z04-69）。 |
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| 中文摘要: |
| 目的 探讨能谱CT血管成像（CTA）区分颈动脉粥样硬化斑块成分的可行性，并分析斑块类型与脑梗死的相关性。方法 对60例经超声检出的颈动脉狭窄患者行头颈部能谱CTA和颅脑MRI。分别测量斑块、脂肪、肌肉和骨骼组织的CT值及有效原子序数，获得40~140 keV单能量图像平均CT值的特征能谱曲线，计算能谱曲线斜率。根据MRI结果评估患者是否存在脑梗死；根据能谱CTA结果将斑块分为脂质斑块、脂质核心为主的混合斑块、纤维成分为主的混合斑块、纤维斑块及钙化斑块，将脂质斑块和脂质/纤维混合斑块归为不稳定斑块，纤维斑块和钙化斑块归为稳定斑块。比较各斑块的能谱曲线斜率及有效原子序数差异；计算存在各类型斑块患者的脑梗死发生率。结果 共纳入109个斑块，包括21个脂质斑块、11个脂质核心为主混合斑块、30个纤维成分为主混合斑块、15个纤维斑块及32个钙化斑块。各斑块能谱曲线斜率及有效原子序数差异均有统计学意义（F=1 494.83、2 108.74，P均<0.01）。19例存在脂质斑块，11例见脂质核心为主混合斑块，19例存在纤维成分为主混合斑块，10例见纤维斑块，20例见钙化斑块。MRI于各类型斑块患者中分别检出13例、6例、7例、2例及1例脑梗死，相应脑梗死发生率分别为68.42%（13/19）、54.55%（6/11）、36.84%（7/19）、11.11%（1/9）及0（0/20）；60例总体脑梗死发生率为45.00%（27/60），其中存在不稳定斑块和稳定斑块患者脑梗死发生率分别为53.06%（26/49）和3.33%（1/30）。结论 能谱CTA可用于细化分析颈动脉斑块成分及类型。斑块脂质成分越多，稳定性越差，患者发生脑梗死的风险越高。 |
| 英文摘要: |
| Objective To investigate the feasibility of energy spectrum CT angiography (CTA) in distinguishing the components of atherosclerosis plaque in carotid artery, and to analyze the relationship of different type atherosclerosis plaque with cerebral infarction. Methods Energy spectrum CTA and head MRI were performed on 60 patients with carotid artery stenosis detected with ultrasound. CT value and effective atomic number of plaque, fat, muscle and bone tissue were measured, respectively. The characteristic energy spectrum curve of average CT value in 40-140 keV single energy image were obtained, and slope of energy spectrum curve was calculated. Cerebral infarction was evaluated based on MRI results. According to the results of energy spectrum CTA, the plaques were divided into lipid plaque, lipid core-dominated mixed plaque, fibrous composites-dominated mixed plaque, fibrous plaque and calcified plaque. The lipid plaque and lipid/fiber mixed plaque were classified as unstable plaque, and the fibrous plaque and calcified plaque were classified as stable plaque. The differences of the slope of energy spectrum curve and effective atomic number in patients of each type plaques were compared. The incidences of cerebral infarction in patients with various types of plaques were correlated. Results A total of 109 carotid plaques were enrolled, including 21 lipid plaque, 11 lipid core-dominated mixed plaque, 30 fibrous composites-dominated mixed plaque, 15 fibrous plaque and 32 calcified plaque. Statistical differences of the corresponding energy curve slope and effective atomic number wer found among different type plaques (F=1 494.83, 2 108.74, both P<0.01). Totally 19, 11, 19, 10 and 20 patients were found with lipid plaque, lipid core-dominated mixed plaque, fibrous composites-dominated mixed plaque, fibrous plaque and calcified plaque, among them MRI detected cerebral infarction in 13, 6, 7, 2 and 1 patient, and the incidence of cerebral infarction was 68.42% (13/19), 54.55% (6/11), 36.84% (7/19), 11.11% (1/9), and 0 (0/20), respectively. The incidence of cerebral infarction in all 60 patients was 45.00%(27/60, in those with unstable plaque or stable plaque was 53.06% (26/49) and 3.33% (1/30), respectively. Conclusion Energy spectrum CTA could be used for detailed analysis on the components and types of carotid plaques. The more the lipid components of plaque, the worse its stability, and the higher the risk of cerebral infarction. |
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