颈动脉粥样硬化斑块特征、血管周围脂肪影像学特征与急性缺血性脑卒中事件的关系——颈动脉CTA分析

The Relationship between Carotid Atherosclerotic Plaque Characteristics, Perivascular Fat Imaging Characteristics, and Acute Ischemic Stroke Events—Carotid CTA Analysis

摘要: 目的：分析颈动脉粥样硬化斑块特征及血管周围脂肪影像学特征与缺血性事件发生的相关性，有助于理解缺血性脑卒中发生的病理生理机制，从而帮助临床医师制定更加个体化的治疗方案。方法：回顾性分析于本院就诊的动脉粥样硬化患者共84例，并同时进行了CTA、颅脑MRI平扫检查，最终经过排除标准筛选后纳入本研究共60例。根据MRI检查结果将患者分为症状组(33例)和无症状组(27例)，比较两组患者间的临床资料、斑块影像学特征及血管周围脂肪密度的差异。将症状组患者根据颈动脉狭窄程度分为轻中度狭窄组(10%~69%)、重度狭窄组(70%~99%)。比较两组间患者的斑块侧颈动脉PFD、非斑块侧颈动脉PFD及∆PFD (HU)的差异。结果：病变血管的狭窄程度、斑块类型、∆PFD为动脉粥样硬化患者发生缺血性事件的风险因素(血管狭窄程度：69.70% vs. 44.44%，P < 0.05；斑块类型：51.52% vs. 22.22%，P < 0.05；∆PFD：30.82 ± 3.40 vs. 27.90 ± 5.30，P < 0.05)；轻中度颈动脉狭窄患者∆PFD低于重度颈动脉狭窄患者(28.50 ± 3.25 vs. 31.97 ± 2.95, P < 0.05)。结论：病变血管的狭窄程度、斑块类型、ΔPFD为缺血性事件发生的影响因素，PFD可能与斑块的稳定性存在相关性，提示了PFD能够作为评估斑块炎症活性的指标。

Abstract: Objective: To analyze the correlation between the characteristics of carotid atherosclerotic plaques and the imaging features of perivascular fat with the occurrence of ischemic events, which aids in understanding the pathophysiological mechanisms underlying ischemic stroke, thereby assisting clinicians in formulating more individualized treatment plans. Methods: A retrospective analysis was conducted on 84 patients with atherosclerosis who visited our hospital. All patients underwent CTA and plain brain MRI scans, and 60 cases were finally included in this study after exclusion criteria were applied. Patients were divided into a symptomatic group (33 cases) and an asymptomatic group (27 cases) based on MRI results. The clinical data, plaque imaging characteristics, and perivascular fat density differences between the two groups were compared. Patients in the symptomatic group were further divided into mild to moderate stenosis group (10%~69%) and severe stenosis group (70%~99%) based on the degree of carotid stenosis. Differences in PFD of the plaque-side carotid artery, PFD of the non-plaque-side carotid artery, and ΔPFD(HU) between the two groups were compared. Results: The degree of stenosis of the diseased vessels, plaque type, and ΔPFD are risk factors for ischemic events in patients with atherosclerosis (degree of vascular stenosis: 69.70% vs. 44.44%, P < 0.05; plaque type: 51.52% vs. 22.22%, P < 0.05; ΔPFD: 30.82 ± 3.40 vs. 27.90 ± 5.30, P < 0.05); ∆PFD in patients with mild to moderate carotid stenosis is lower than in patients with severe carotid stenosis (28.50 ± 3.25 vs. 31.97 ± 2.95, P < 0.05). Conclusion: The degree of stenosis in the diseased vessel, plaque type, and ∆PFD are influencing factors for the occurrence of ischemic events. PFD may be correlated with plaque stability, suggesting that PFD can serve as an indicator for evaluating plaque inflammatory activity.