| BackgroundIntracranial atherosclerotic disease?ICAD?is one of the common causes of ischemic cerebral infarction,in which the middle cerebral artery?MCA?is the most frequently involved site.For many years,the stenosis rate is usually used to evaluate the severity of the disease in ICAD patients.It is considered that the stenosis rate is an accurate reflection of the plaque burden.The conventional methods for evaluating the stenosis rate are mainly based on angiography.However,there is increasing evidence that determinants of cerebral infarction have plaque characteristics in addition to the degree of vascular stenosis[1].Therefore,there is an urgent need for an accurate and safe examination method to evaluate the intracranial blood vessel wall.3D Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions?3D-SPACE?technology not only can evaluate the stenosis rate of pathological vascular,but also can directly describe the characteristics of the plaque,so as to comprehensively evaluate the stability of the plaque.This topic closely follows current clinical research hotspots.By comparing the difference in plaque characteristics between patients with ischemic infarction and patients with Transient ischemic attacks?TIA?,the application value of 3d-space technology in intracranial atherosclerotic plaques was discussed.Objective1.To quantitatively analyze the plaque characteristics of patients with ischemic cerebral infarction and transient ischemic attack,compare the differences between their plaque characteristics,and explore the diagnostic efficacy of these indicators.2.To explore the relationship between the degree of plaque enhancement in the middle cerebral artery and the perfusion of downstream brain tissue.MethodsIn the first part,a total of 45 patients with symptomatic middle cerebral artery stenosis admitted to Henan provincial people's hospital from November 2017 to February 2019 were included.21patients with DWI high signal in the middle cerebral artery blood supply area were enrolled in the cerebral infarction group,and the remaining 24 patients with no DWI high signal in the middle cerebral artery blood supply area were included in the transient ischemic attack group.All patients underwent routine MRI,TOF-MRA imaging,and pre-and post-contrast 3D-SPACE imaging using a 3.0T MR scanner within 2 weeks after symptom onset.Quantitative measurement the stenosis rate,eccentricity index,remodeling index and contrast enhancement in the two groups.Analysis of the relationship between plaque characteristics and cerebral infarction and TIA,evaluate the diagnostic performance of each parameter in predicting the occurrence of cerebral infarction.Of the 45 patients,31 patients?16 patients with cerebral infarction and 15patients with TIA?underwent dynamic MRI perfusion imaging?PWI?.The degree of enhancement of the cerebral artery plaque in the patient's brain and the rMTT,rrCBV,and rrCBF perfusion parameters of the brain tissue area of the lesion downstream of the lesion were measured.The relationship between the contrast enhancement in patients and the perfusion parameters of brain tissue downstream of the lesion was analyzed.ResultsThe remodeling index and contrast enhancement of patients with cerebral infarction were significantly higher than those of TIA patients?remodeling index:0.862±0.246 vs.0.704±0.182,P=0.018<0.05;contrast enhancement:1.392±0.509 vs.1.065±0.472,P=0.030<0.05?.There was no significant difference in the stenosis rate between the two groups?67.6%±21.1%vs.66.5%±14.5%,P>0.05?.There was no significant difference in eccentricity index between the two groups?1.298±0.517 vs.1.093±0.533,P>0.05?.The AUC?95%CI?for determining the occurrence of stroke was 0.694 for the remodeling index and0.669 for contrast enhancement.The AUC?95%CI?for combination of remodeling index and contrast enhancement was 0.760.The contrast enhancement was positively correlated with rMTT?r=0.528,P=0.002?,and had no significant correlation with rrCBV?r=0.085,P=0.650?,and rrCBF?r=-0.317,P=0.082?.Conclusions1.3D-SPACE can accurately quantitative analysis of patch characteristics,including refactoring index and plaque reinforcement degree to evaluate the stability of the plaques,thus can as soon as possible to the MCA atherosclerotic patients for effective risk assessment and treatment in time,prevent the deterioration of disease and cerebral infarction,the occurrence of symptoms,should be widespread popularization and application in clinic.2.3D-SPACE technology can evaluate the severity of cerebral tissue perfusion injury to a certain extent and provide incremental information related to cerebral tissue perfusion for patients with middle cerebral artery atherosclerosis.3.3D-SPACE technology can be used as an important examination method for high-risk patients with ICAD,so as to know whether there are intracranial vascular plaques and identify unstable plaques as early as possible. |
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