【作者】 赵倩；

【导师】 蔡祖龙；

【作者基本信息】 中国人民解放军军医进修学院 ， 影像医学与核医学， 2009， 博士

【摘要】 第一部分冠状动脉钙化积分与颈动脉粥样硬化的相关性分析目的:探讨冠状动脉钙化与颈动脉粥样硬化病变的相关性。材料和方法:本研究选取123例临床怀疑冠状动脉病变的患者,所有患者在双源CT扫描机上进行低剂量钙化积分(CACS)的扫描,并于两周内完成双侧颈动脉的多对比加权的MR成像。颈动脉MR扫描在3.0T磁共振机上完成,对每一层图像进行颈动脉斑块形态学及斑块成分的评价。形态学指标的测量包括:管腔面积(LA)、管壁面积(WA)、总血管面积(TVA)、平均管壁厚度(MWT)、管壁标准化指数(NWI)。所测双侧颈动脉指标的平均值作为该患者此项指标的结果。颈动脉斑块成分及特点的评价指标包括:钙化、富含脂质的坏死核(LRNC)、斑块内出血(IPH)及斑块表面破裂。CT和MR图像分析采用双盲法进行,其中MR图像分析由两名专业人员使用分析软件CASCADE辅助完成。按CACS的高低将患者分为高CACS组(CACS≥400)和低CACS组(CACS＜400),按CACS的分值分为4个不同等级:0级(CACS=0),1级(CACS=1～100),2级(CACS=101～400),3级(CACS＞400)。不同CACS组及等级之间颈动脉指标的比较分别采用t检验和单因素方差分析,应用Spearman等级相关方法分析CACS与颈动脉斑块内成分及其容积的相关性。当p＜0.05时定义为具有显著性统计学意义。结果:CACS与颈动脉平均WA和MWT呈中等度正相关(r值分别为0.521、0.556),与TVA和NWI呈弱正相关(r值分别为0.215、0.377),而与LA无明显相关。高CACS组的平均WA、TVA和MWT明显大于低CACS组。随着CACS等级的增加,颈动脉斑块负荷(WA、TVA、MWT、NWI)均呈增高的趋势。颈动脉斑块钙化和LRNC的出现几率与CACS明显相关。颈动脉斑块IPH和斑块表面破裂的出现与CACS没有明显相关性。CACS与颈动脉斑块内钙化、LRNC的容积呈中等程度正相关,与IPH容积呈弱相关。结论:CACS与颈动脉的斑块负荷、斑块内成分具有明显相关性。CACS对颈动脉斑块负荷和斑块内成分具有一定的预测价值。第二部分冠状动脉狭窄程度与颈动脉重构效应的相关性分析目的:探讨冠状动脉狭窄程度与颈动脉血管重构效应的关系。材料和方法:本研究共纳入123例临床怀疑冠状动脉病变的患者,所有患者在双源CT机上进行冠状动脉CTA检查,并于两周内完成双侧颈动脉多对比加权MR成像。采用美国心脏协会(AHA)推荐的15分段法分析冠状动脉树,评价每一个血管节段管腔狭窄程度。将管腔狭窄分为5级,0级:管腔正常;1级:管腔狭窄1%～29%;2级:管腔狭窄30%～49%;3级:管腔狭窄50%～69%;4级:管腔狭窄70%～100%。CT和MR图像分析采用双盲法进行,其中MR图像分析由两名专业人员使用分析软件CASCADE辅助完成。颈动脉MR形态学指标包括:管腔面积(LA)、管壁面积(WA)、总血管面积(TVA)、平均管壁厚度(MWT)、管壁标准化指数(NWI)。对每一层面进行上述指标的测量,所测双侧颈动脉指标的平均值作为该患者此项指标的结果。另外,对颈动脉的3个不同节段:颈内动脉(ICA)、球部(Bulb)和颈总动脉(CCA)分别进行上述指标的计算。应用spearman等级相关方法分析冠状动脉狭窄程度与颈动脉形态学指标的相关性。结果:冠状动脉狭窄等级与颈动脉WA、MWT、NWI呈正相关,相关指数r分别为0.396、0.438、0.348。随着冠状动脉狭窄等级增加,颈内动脉LA减小、WA增大、TVA无明显变化;颈总动脉的WA、TVA增大,LA无明显变化;颈动脉球部WA增大,LA和TVA无明显变化。结论:冠状动脉狭窄程度与颈动脉负荷具有明显正相关。随着冠状动脉狭窄程度的加重,颈总动脉表现为正性重构效应,颈内动脉表现为负性重构效应。第三部分冠状动脉与颈动脉粥样硬化斑块成分的相关性分析目的:探讨冠状动脉与颈动脉斑块成分的相关性。材料与方法:本研究共纳入123例临床怀疑冠状动脉病变的患者,所有患者在双源CT机上进行冠状动脉CTA检查,并于两周内完成双侧颈动脉多对比加权MR成像。采用美国心脏协会(AHA)推荐的15分段法分析冠状动脉树,评价每一个血管节段的斑块类型。根据CT值的大小将冠状动脉斑块分为非钙化斑块、钙化斑块和混合斑块三种类型。对每个患者的斑块类型进行分析,每一种斑块类型的数量总和即为该类型斑块的计数。双侧颈动脉任意一侧出现斑块内钙化、LRNC或IPH,则该患者的该项指标记为阳性。分析冠状动脉不同斑块类型与颈动脉斑块成分的相关性。结果:冠状动脉混合斑块计数与颈动脉IPH具有明显相关性(OR=1.50,P＜0.05)。冠状动脉三种斑块类型均与颈动脉LRNC及钙化具有明显相关性(p＜0.05)。在判断颈动脉斑块是否出现IPH方面,冠状动脉混合斑块计数具有较高的诊断效能(AUC=0.74)。在判断颈动脉斑块是否出现LRNC及钙化方面,冠状动脉钙化斑块计数具有较高的诊断效能(AUC均为0.75)。结论:冠状动脉斑块类型与颈动脉斑块成分具有明显的相关性。冠状动脉混合斑块可能是颈动脉高危斑块的一个预示因素。更多还原

【Abstract】 Part One Association between Coronary Artery Calcium Score and Carotid Atherosclerotic DiseaseObjective:To evaluate the association between coronary calcification and carotid atherosclerosis.Materials and methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study.A pre-contrast low-dose CT scan was performed for all the subjects to measure the coronary artery calcium score(CACS) by a Dual Source CT scanner.Multi-contrast carotid magnetic resonance imaging(MRI) was performed by a 3.0T MR scanner within two weeks after coronary CT scan.The parameters of the carotid morphological measurement,including lumen area(LA),wall area(WA),total vessel area(TVA), mean wall thickness(MWT),and normalized wall index(NWI),were measured for each location.The mean value of each measurement was calculated for bilateral carotid arteries of each subject.The presence or absence of carotid plaque tissue compositions,including calcification(CA),lipid-rich necrotic core (LRNC),and intraplaque hemorrhage(IPH),was recorded for each subject.The plaque surface disruption was also recorded.Two reviewers blinded to CACS results interpreted MR images with consensus using customer-designed software (CASCADE).All subjects were divided into two groups:high-CACS group (CACS≥400) and low-CACS group(CACS＜400).Furthermore,CACS was partitioned as following categories:scores of 0 as grade 0,scores of 1-100 as grade 1,101-400 as grade 2,and＞400 as grade 3.The carotid morphological measurements in all the CACS groups and categories were compared using independent t test and one way ANOVA,respectively.The correlation between CACS and presence of carotid plaque compositions was analyzed using Spearman’s correlation analysis.A P-value less than 0.05 was considered statistical significance.Results:CACS showed moderate correlation with carotid WA(r=0.521) and MWT(r=0.556),weak correlation with TVA(r=0.215) and NWI(r=0.377).There was no significant correlation between CACS and carotid LA(p＞0.05).Compared to low-CACS group,high-CACS group showed larger carotid WA,TVA and MWT.In the entire cohort,carotid plaque burden showed an increasing trend with CACS increasing.Significant correlation was found between CACS and presence of carotid CA and LRNC.There was no significant correlation of CACS with carotid IPH and surface disruption.CACS showed moderate correlation with carotid calcification volume and LRNC volume,weak correlation with carotid IPH volume.Conclusion:CACS significantly associates with carotid atherosclerotic plaque burden and the presence of tissue compositions.CACS may be a predictor for carotid plaque burden and tissue compositions. Part Two Association between Coronary Stenosis and Carotid Artery RemodelingObjective:To investigate the relationship between coronary stenosis on CT and carotid artery remodeling on MRI.Materials and Methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study All the patients obtained CT angiography(CTA) by a Dual Source CT scanner.Multi-contrast carotid magnetic resonance imaging(MRI) was performed in bilateral carotid arteries within two weeks after coronary CT scan.Coronary segmental evaluation was performed according to AHA classification and subdivision of coronary arteries into 15 segments.Coronary artery luminal stenosis was partitioned into five grades:grade 0(normal coronary artery),grade 1(1%-29%stenosis),grade 2(30%-49% stenosis),grade 3(50%-69%stenosis),and grade 4(70%-100%stenosis).Two reviewers blinded to coronary results interpreted MR images with consensus using customer-designed software(CASCADE).The parameters of the carotid morphological measurement,including lumen area(LA),wall area(WA),total vessel area(TVA),mean wall thickness(MWT),and normalized wall index (NWI),were measured for each location.The overall mean value of each measurement was calculated for bilateral carotid arteries of each subject.In addition,the mean value of these morphological measurements was also calculated in three segments of carotid artery:in internal carotid artery(ICA), bulb,and common carotid artery(CCA).The association of coronary stenosis with carotid morphological measurements was analyzed using Spearman’s correlation analysis.Results:Coronary stenosis showed positive correlation with carotid WA(r=0.396), MWT(r=0.438) and NWI(r=0.348).In the segment of ICA,LA and WA showed negative and positive correlation with coronary stenosis,respectively.However, there was no significant correlation between TVA and coronary stenosis.In the segment of CCA,WA and TVA showed positive correlation with coronary stenosis. No significant correlation between LA and coronary stenosis can be found.In the segment of Bulb,WA showed positive correlation with coronary stenosis.There was no significant correlation of coronary stenosis with LA and TVA.Conclusions:Coronary stenosis is significantly positive correlated with carotid plaque burden.There might be positive remodeling in CCA and negative remodeling in ICA with coronary stenosis progressing. Part Three Correlation of Atherosclerotic Plaque Compositions in Coronary and Carotid ArteriesObjective:To evaluate the relationship between coronary and carotid plaque compositions.Materials and methods:One hundred and twenty-three subjects with suspected coronary artery disease were recruited in this study.All the patients obtained CT angiography(CTA) examination by a Dual Source CT scanner.Carotid multi-contrast magnetic resonance imaging(MRI) was performed in bilateral arteries within two weeks after coronary CT scan.Coronary segmental evaluation was performed according to AHA classification and subdivision of coronary arteries into 15 segments.Coronary plaques were classified into three types based on CT attenuation value(HU):non-calcified,calcified,and mixed plaques.The presence or absence of coronary plaques was visually scored.Each type of plaque score was recorded according to the number of corresponding type of plaque for each subject.The presence or absence of carotid plaque tissue compositions, including calcification(CA),lipid-rich necrotic core(LRNC),and intraplaque hemorrhage(IPH),was identified for each subject.The relationship between different type of coronary plaques and carotid tissue compsitions was evaluated.Results:Significant correlation of carotid IPH with mixed plaque score (OR=1.50 ) was found.There was significant correlation between three types of plaque scores in coronary artery and LRNC and calcification in carotid artery.In classifying subjects with and without carotid IPH,coronary mixed plaque score showed the highest AUC(0.74).In classifying subjects with and without carotid LRNC and calcification,coronary calcified plaque score showed the highest AUC (0.75).Conclusions:Coronary plaque types significantly associate with carotid plaque compositions.Coronary mixed plaque might be a predictor for carotid high risk plaque features更多还原