MSCTA在颈动脉粥样硬化与缺血性脑卒中相关性研究中的应用

摘要

ObjectiveTo investigate the application of multi-slice spiral CT angiography (MSCTA) in study on the correlation between carotid artery atherosclerosis and cerebral ischemic stroke.Methods The MSCTA imaging data of 180 patients with suspected cerebral ischemic stroke were retrospectively studied. Patients were divided into two groups: Ischemic Stroke Group (87 cases) and Non-Ischemic Stroke Group (93 cases). CTA image quality was firstly evaluated. Then, comparison between the two groups was done based on characterization of carotid plaque, location and degree of artery stenosis. Finally, logistic regression analysis was used to screen the risk factors of ischemic stroke.Results Among 360 carotid arteries in 180 patients, two carotid arteries were unavailable for analysis in this study because of bad image quality. Altogether 358 carotid artery patients (172 patients in Ischemic Stroke Group, 186 in Non-Ischemic Stroke Group) were evaluated. There was no difference in the image quality between two groups. Severe artery stenosis was markedly different between the two groups (χ2=11.80;P=0.001). A total of 841 plaques were revealed, among which 411 plaques were found in Ischemic Stroke Group and 430 in Non-Ischemic Stroke Group. Characteristics of carotid plaque were signiifcantly different between two groups (χ2=11.47;P=0.001). Unstable plaques in Ischemic Stroke Group were more than those of Non-Ischemic Stroke Group. Conversely, Non-Ischemic Group had more stable plaques. Logistic analysis showed that unstable plaque was the most important risk factor for cerebral ischemic stroke (P<0.05).Conclusion MSCTA was a reliable imaging method for evaluating carotid artery atherosclerosis. There was signiifcant and certain correlation between carotid artery atherosclerosis and cerebral ischemic stroke.%目的：探讨多层螺旋CT血管造影（MSCTA）在颈动脉粥样硬化与缺血性脑卒中相关性研究中的应用。方法回顾性分析180例脑卒中患者的MSCTA检查资料，其中缺血性脑卒中87例，非缺血性脑卒中93例。首先对图像质量进行评价，其次对比两组患者颈动脉狭窄程度及颈动脉斑块部位、性质，最后采用Logistic回归分析筛选缺血性脑卒中的相关危险因素。结果①180例患者的360支颈动脉血管中，2支颈动脉图像质量较差不能用于分析，358支血管（缺血性脑卒中组172支，非缺性脑血卒中组186支）最终纳入研究，两组间图像质量比较无显著差异；②缺血性脑卒中组颈动脉重度狭窄病例明显多于非缺血性脑卒中组（χ2=11.80，P=0.001）；③缺血性脑卒中组检出斑块411个，非缺血性脑卒中组430个。两组间斑块性质有显著差异（χ2=11.47，P=0.001），缺血性脑卒中组以不稳定斑块多见，非缺性脑血卒中组则以稳定斑块多见；④ Logistic回归分析结果提示，颈动脉狭窄、不稳定斑块均是缺血性脑卒中的重要危险因素（P＜0.05），其中以不稳定斑块更为重要。结论 MSCTA是评价颈动脉粥样硬化的可靠影像学方法，颈动脉狭窄程度及粥样硬化斑块性质与缺血性脑卒中有一定的相关性，不稳定斑块是引起缺血性脑卒中最重要的危险因素。