3D HR-VW-MRI对颅内动脉粥样硬化斑块特征与复发性急性脑卒中的关联性研究

张凤令; 张艳丽; 张平; 张慧荣; 付彦; 郑伟

doi:10.15953/j.ctta.2025.208

3D HR-VW-MRI对颅内动脉粥样硬化斑块特征与复发性急性脑卒中的关联性研究

Association Between Intracranial Atherosclerotic Plaque Characteristics and Recurrent Acute Stroke: Insights from Three-dimensional High-Resolution Vessel Wall Magnetic Resonance Imaging

摘要

摘要: 目的：探究3D高分辨率血管壁磁共振成像（3D HR-VW-MRI）颅内Willis环动脉粥样硬化（ICAD）斑块特征与复发性急性脑卒中的关系。方法：回顾性纳入119例ICAD致缺血性卒中患者，分为首次急性卒中组（n=68）和复发性急性卒中组（n=51）。所有患者行3D HR-VW-MRI，评估颅内总斑块数量及责任斑块特征（面积、体积、出血、负荷、狭窄程度）。采用逻辑回归及ROC曲线分析确定卒中复发的独立危险因素。结果：与首次急性卒中组相比，复发组患者入院NIHSS评分更高（P < 0.001），合并糖尿病、冠心病比例更高（P=0.016，P=0.045）。复发组颅内总斑块数量更多（P < 0.001）、责任斑块体积更大（P=0.008）、斑块内出血比例更高（P < 0.001）、斑块负荷更高（P=0.028）。多变量分析（独立危险因素）：总斑块数量（OR=1.40，95% CI 1.20~1.70，P=0.001）；斑块体积（OR=1.80，95% CI 1.10~3.00，P=0.020）；斑块出血（OR=3.20，95% CI 1.50~6.80，P < 0.001）；预测卒中复发危险因素的曲线下面积（AUC），斑块总数的AUC为0.809（95% CI 0.731~0.888），斑块出血的AUC为0.690（95% CI 0.590~0.790），斑块体积AUC为0.863（95% CI 0.795~0.931）。结论：ICAD患者颅内总斑块数量增多、责任斑块体积增大及斑块内出血是卒中复发的独立危险因素，可作为预测和分层卒中复发风险的影像学标志物。

Abstract:
Objective Using three-dimensional high-resolution vessel wall magnetic resonance imaging (3D HR-VW-MRI), we analyzed the characteristics of intracranial atherosclerotic disease (ICAD) plaques within the circle of Willis, in order to investigate the relationship of ICAD with recurrent acute stroke.
Methods A total of 119 patients with ischemic stroke caused by ICAD were retrospectively enrolled and divided into two groups: the first-ever acute stroke group (n=68) and the recurrent acute stroke group (n=51). All the patients underwent 3D HR-VW-MRI. The total number of intracranial plaques and the characteristics of the culprit plaques (including area, volume, intraplaque hemorrhage (IPH), plaque burden, and stenosis degree) were assessed. Logistic regression and receiver operating characteristic curve analyses were performed to identify the independent risk factors for stroke recurrence.
Results Compared with the first-ever stroke group, patients in the recurrent stroke group had significantly higher scores based on the National Institutes of Health Stroke Scale (NIHSS) (P < 0.001) and a higher prevalence of diabetes mellitus (P=0.016) and coronary artery disease (P=0.045). The recurrent stroke group exhibited a significantly greater total number of intracranial plaques (P < 0.001), larger culprit plaque volume (P=0.008), higher prevalence of IPH (P < 0.001), and higher plaque burden (P=0.028). The results of the multivariate analysis (independent risk factors for recurrence) were as follows: total plaque number (odds ratio OR=1.40, 95% confidence interval CI 1.20–1.70, P=0.001); plaque volume (OR=1.80, 95% CI 1.10–3.00, P=0.020); and presence of IPH (OR=3.20, 95% CI 1.50–6.80, P < 0.001). The predictive performance of the analysis was measured by the area under the curve (AUC): total plaque number, AUC=0.809, (95% CI 0.731–0.888); presence of IPH, AUC=0.690, (95% CI 0.590–0.790); and plaque volume, AUC=0.863, (95% CI 0.795–0.931).
Conclusion In patients with ICAD, an increased total number of intracranial plaques, larger culprit plaque volume, and the presence of intraplaque hemorrhage were found to be independent risk factors for recurrent stroke. These plaque characteristics serve as valuable imaging markers for predicting and stratifying the risk of stroke recurrence.

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