Clinical Study Of High-resolution Magnetic Resonance MATCH Sequence And Conventional Sequence In Diagnosis Of Carotid Plaque

Objective:1.In order to investigate the diagnostic value of high-resolution magnetic resonance MATCH sequence for carotid plaque by comparing the difference between high-resolution magnetic resonance MATCH sequence and conventional sequence in the diagnosis of carotid plaque load,composition and vulnerability.2.To explore the correlation between the vulnerability of carotid plaque with mild to moderate stenosis and clinical indicators,and to provide reference for the early prevention and treatment of vulnerable carotid plaque.3.In order to provide a scientific basis for the objectification of TCM syndrome types of carotid plaques,the laws of carotid plaque load,composition and vulnerability of different TCM syndrome types were analyzed by conventional high-resolution magnetic resonance sequence.4.To investigate the effects of atorvastatin on carotid plaques with mild to moderate stenosis,the Changes of plaque load,composition,vulnerability and Crouse score in patients with mild to moderate stenosis of carotid plaque under different intervention conditions were observed by conventional high-resolution magnetic resonance sequence.Methods:1.From September 2017 to February 2019,64 patients with mild to moderate stenosis of carotid plaque confirmed by carotid ultrasound were collected from the Department of Neurology and physical examination center of Shenzhen Longgang central hospital.Patients were scanned using Siemens Prisma 3.0T magnetic resonance and a carotid-specific 8-channel coils.Scan sequences include high-resolution magnetic resonance MATCH sequence and conventional sequences(T1WI,T2WI,PDWI,3D-TOF,and T1WI enhancement).The scanning range is 3 cm up and down with the carotid bifurcation as the center,and the axial scanning is the main part of each sequence.VesselMass software was used for imaging post-processing and measurement.The plaque load indexes(PV,MWT,WA,LA,NWI),plaque composition(IPH,CA,LRNC)and plaque vulnerability evaluated by MATCH sequence and conventional sequence were compared.2.According to the plaque vulnerability of 64 patients with mild to moderate stenosis of carotid plaque,they were divided into vulnerable plaque group and stable plaque group.At the same time,general data(age,gender,height,weight,BMI index),personal history(smoking history,drinking history),past history(diabetes,hypertension,stroke,coronary heart disease history)and blood biochemical indexes(total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein and fasting blood glucose)of the two groups of patients were obtained.The difference of clinical indexes between vulnerable plaque group and stable plaque group was analyzed by univariate analysis,and then the clinical indexes with statistical difference in univariate analysis were analyzed by binary logistic regression analysis to screen the clinical indexes related to carotid plaque vulnerability.3.The images of 64 patients with mild to moderate stenosis of carotid plaque were post-processed and measured by VesselMass software.At the same time,the TCM clinical information of all patients was collected,and the dialectical classification of TCM was performed according to the diagnostic criteria agreed by experts for the diagnosis and treatment of atherosclerosis with integrated traditional Chinese and Western medicine.According to the expert consensus diagnostic criteria,all patients were divided into four types:phlegm and blood stasis syndrome,Qi-Yin deficiency syndrome,qi stagnation and blood stasis syndrome and Qi deficiency and blood stasis syndrome.The differences of carotid plaque load indexes(PV,MWT,WA,LA,NWI),plaque composition(IPH,CA,LRNC),plaque enhancement and plaque vulnerability of different TCM syndrome types were analyzed.4.From September 2017 to February 2019,34 patients with mild to moderate stenosis of carotid plaque confirmed by carotid ultrasound were collected from the Department of Neurology and physical examination center of Shenzhen Longgang central hospital.the patients were followed up for half a year.The patients were divided into treatment group and control group according to whether they took atorvastatin.The patients in the treatment group took atorvastatin 10mg/day,the patients in the control group did not take any lipid-lowering drugs,and the intervention time was half a year.Before and after the intervention,magnetic resonance conventional sequences(T1WI,T2WI,PDWI,3D-TOF,T1WI+C)scans were performed on all the patients.VesselMass software was used for imaging post-processing and measurement.Carotid plaque load indexes(PV,MWT,WA,LA,NWI),plaque composition(IPH,CA,LRNC),plaque vulnerability,and Crouse score were compared between the two groups of patients before and after the intervention.Results:1.There was no significant difference in plaque volume,maximum wall thickness,wall area,and standardized wall index detected by the MATCH sequence and the conventional T1WI+C sequence(P>0.05),while the detected lumen area was significantly different(P<0.05).The plaque composition and vulnerability detected by the MATCH sequence were consistent with those detected by conventional sequence.They had excellent consistency in intra-plaque hemorrhage and calcification(kappa=1,P<0.01;kappa=0.97,P<0.01),and a satisfactory consistency in lipid-rich necrotic core and plaque vulnerability(kappa=0.705,P<0.01;kappa=0.714,P<0.01).2.There were 56 plaques in the vulnerable plaque group and 73 plaques in the stable plaque group.The results of univariate analysis showed that there were significant differences between the vulnerable plaque group and the stable plaque group in five clinical indicators:high-density lipoprotein,low-density lipoprotein,stroke,smoking and drinking(P<0.05).Binary Logistic regression analysis showed that the vulnerability of carotid plaque with mild to moderate stenosis was correlated with LDL-C and smoking.LDL-C was positively correlated with vulnerable carotid plaque(B=1.238>0,OR=3.449>1).The risk of vulnerable carotid plaque in LDL-C>3.10mmol/l was 3.449 times higher than that in LDL-C<2.70mmol/l.Smoking was positively correlated with vulnerable carotid plaque(B=1.317>0,OR=3.731>1).The risk of vulnerable carotid plaque in smokers was 3.731 times higher than that in nonsmokers.3.There were 64 patients with carotid plaque,including 22 cases of phlegm and blood stasis syndrome(34.4%,male 19/female 3),15 cases of qi stagnation and blood stasis syndrome(23.4%,male 9/female 6),and Qi-Yin deficiency syndrome 15 cases(23.4%,male 6/female 9)and 12 cases of qi deficiency and blood stasis syndrome(18.8%,male 6/female 6).There was no significant difference in the proportion,age and BMI index of different TCM syndromes(P<0.05),but there was significant difference in the gender ratio(P>0.05).The male proportion of phlegm and blood stasis syndrome was significantly higher than that of Qi-Yin deficiency syndrome.There were significant differences in carotid plaque volume,maximum wall thickness,and wall area of the different TCM syndrome types(P<0.05),and there was no significant difference in lumen area and standardized wall index(P>0.05).The plaque volume,the maximum wall thickness and the wall area of the patients with phlegm and blood stasis syndrome were significantly larger than those with Qi stagnation and blood stasis syndrome,Qi-Yin deficiency syndrome and Qi deficiency and blood stasis syndrome.The plaque volume of the patients with Qi stagnation and blood stasis syndrome was significantly larger than that of the patients with Qi deficiency and blood stasis(P<0.05).There was a significant difference in the incidence of calcification of carotid plaque in different TCM syndromes(P<0.05).The incidence of calcification in Qi stagnation and blood stasis syndrome was significantly higher than that in phlegm and blood stasis syndrome and Qi deficiency and blood stasis syndrome(P<0.05).There was a significant difference in the incidence of lipid necrosis core between different TCM syndromes(P<0.05).The incidence of lipid-rich necrotic core in the plaque of phlegm and blood stasis syndrome was significantly higher than that in the plaque of Qi-Yin deficiency syndrome(P<0.05).There was a significant difference in the incidence of carotid plaque enhancement between different TCM syndromes(P<0.05).The incidence of carotid plaque enhancement in phlegm and blood stasis syndrome was significantly higher than that in Qi-Yin deficiency syndrome and Qi deficiency and blood stasis syndrome(P<0.05).The incidence of plaque enhancement in Qi stagnation and blood stasis was significantly higher than that in Qi-Yin deficiency and Qi deficiency and blood stasis(P<0.05).There was a significant difference in the incidence of vulnerable plaque in different TCM syndromes(P<0.05).The incidence of vulnerable plaque in Phlegm and Blood Stasis Syndrome was significantly higher than that in Qi-Yin deficiency syndrome and Qi deficiency and blood stasis syndrome(P<0.05).The incidence of vulnerable plaque in Qi stagnation and blood stasis syndrome was significantly higher than that in Qi-Yin deficiency syndrome and Qi deficiency blood stasis syndrome(P<0.05).4.16 patients in the intervention group and 18 patients in the control group.Before the intervention,there were no significant differences between the treatment group and the control group in terms of plaque load indexes,composition indicators,plaque vulnerability and Crouse score(P>0.05).After intervention,the plaque volume and standardized wall index in the treatment group were significantly smaller than those in the control group(P<0.05),while there was no significant difference in the maximum wall thickness,wall area,lumen area and Crouse score between the two groups(P>0.05).There were significant differences in plaque volume difference,maximum wall thickness difference,wall area difference,lumen area difference,standardized wall index difference and plaque Crouse integral difference between the two groups before and after intervention(P<0.01).The plaque volume difference,the maximum wall thickness difference,the wall area difference,the lumen area difference,the standardized wall index difference and Crouse integral difference in the treatment group before and after the intervention were less than those in the control group(P<0.05).After intervention,compared with the control group,there was no significant difference in the proportion of hemorrhage,calcification,lipid-rich necrotic core and vulnerable plaque in the treatment group.Compared with those before the intervention,there were no significant differences in the proportion of carotid plaque hemorrhage,calcification,lipid necrosis core,and vulnerable plaque in the treatment group(P>0.05).However,after intervention in the control group,the proportion of carotid plaque lipid-rich necrotic core and vulnerable plaque increased significantly,with significant differences(P<0.01).Conclusion:1.MATCH sequence is highly consistent with the conventional sequence for diagnosing the loading,composition and vulnerability of carotid plaque with mild to moderate stenosis,what's more,MATCH sequence has the advantages in short scan time and simple diagnosis,is an efficient clinical imaging diagnosis method.2.LDL-C and smoking are the risk factors for the development of vulnerable carotid plaques with mild to moderate stenosis.With smoking and an increase in LDL-C,the risk of carotid vulnerable plaque increases.3.Carotid plaque Patients with phlegm and stasis syndrome have a large carotid plaque load,a high incidence of lipid-rich necrotic core in the plaque,significant neovascularization and inflammatory response and poor plaque stability.Carotid plaque patients with qi stagnation and blood stasis syndrome have large plaque volume,high incidence of calcification within the plaque,obvious neovascularization and inflammatory response and poor plaque stability.However,carotid plaque patients with qi-yin deficiency syndrome and qi deficiency and blood stasis syndrome have relatively low plaque load,intraplaque hemorrhage,calcification,lipid-rich necrotic core and enhancement,and the plaque is relatively stable.Therefore,we should pay attention to the prevention and treatment of carotid plaque in phlegm and blood stasis syndrome and Qi stagnation and blood stasis syndrome.4.Atorvastatin can reduce plaque load,stabilize plaque composition and control plaque vulnerability in patients with mild to moderate stenosis of carotid plaque.Patients with mild to moderate stenosis of carotid plaque should start lipid-lowering treatment early,no matter whether they have a history of stroke or not,so as to prevent the further development of carotid plaque.