High-resolution magnetic resonance imaging vascular wall characteristics and risk of ischemic stroke in patients with middle cerebral artery atherosclerotic stenosis / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the correlation between the high-resolution magnetic resonance imaging (MRI) vessel wall characteristics and risk of ischemic stroke in patients with middle cerebral artery (MCA) atherosclerotic stenosis.Methods:Patients with ischemic cerebrovascular disease treated in the Department of Neurology, Nanjing First Hospital, Nanjing Medical University from January 2016 to January 2020 were enrolled prospectively. The patients presented with transient ischemic attack or acute ischemic stroke (AIS). Magnetic resonance angiography showed that the ipsilateral MCA had stenosis of 50%-99%, and it was identified as the responsible lesion. Routine MRI and the vessel wall imaging at the narrowest part of MCA were performed. The characteristics of vessels and plaques at MCA stenosis were compared between the AIS group and the non-AIS group. Multivariate logistic regression analysis was used to determine the independent risk factors for AIS. Receiver operating characteristic (ROC) curve was used to determine the predictive value of vessel wall characteristics for AIS. Results:A total of 65 patients with ischemic cerebrovascular disease and MCA stenosis were enrolled. The age of patients was 68±14 years, 50 were males (76.9%). There were 30 patients (46.2%) in the AIS group and 35 (53.8%) in the non-AIS group. There were no significant differences in demographic data, vascular risk factors and routine laboratory tests between the two groups. Compared with the non-AIS group, the narrowest lumen area in the AIS group (2.36±1.09 mm 2vs. 2.96±1.01 mm 2; t=2.274, P=0.027) was smaller, the plaque area (4.46 ±2.08 mm 2vs. 2.62±1.32 mm 2; t=4.315, P<0.001) was larger, the remodeling index (1.08±0.11 vs. 0.94±0.10; t=5.573, P<0.001) was higher, and the proportion of obvious enhanced plaque (63.3% vs. 11.4%; χ2=19.034, P<0.001) and positive remodeling plaque (80.0% vs. 20.0%; χ2=23.311, P<0.001) were higher. Multivariate logistic regression analysis showed that plaque area (odds ratio [ OR] 2.01, 95% confidence interval[ CI] 1.35-2.98; P=0.001), remodeling pattern ( OR 16.00, 95% CI 4.73-54.15; P=0.001), the narrowest lumen area ( OR 0.568, 95% CI 0.34-0.96; P=0.033) and degree of enhancement ( OR 21.85, 95% CI 5.13-93.00; P<0.001) were the independent risk factors for AIS. ROC curve analysis showed that the combination of plaque area, the narrowest lumen area and the degree of enhancement had the best prediction effect (area under the curve 0.927, 95% CI 0.84-0.96). Conclusion:AIS is more likely to occur when the plaque area at the narrowest part of the MCA is larger, the lumen area is smaller, and there is obvious plaque enhancement.