Signal intensity and volume of carotid intraplaque hemorrhage on magnetic resonance imaging and the risk of ipsilateral cerebrovascular events: The Plaque At RISK (PARISK) study.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-06-13 DOI:10.1016/j.jocmr.2024.101049
Kelly P H Nies, Mueez Aizaz, Dianne H K van Dam-Nolen, Timothy C D Goring, Tobien A H C M L Schreuder, Narender P van Orshoven, Alida A Postma, Daniel Bos, Jeroen Hendrikse, Paul Nederkoorn, Rob van der Geest, Robert J van Oostenbrugge, Werner H Mess, M Eline Kooi
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引用次数: 0

Abstract

Background: The Plaque At RISK (PARISK) study demonstrated that patients with a carotid plaque with intraplaque hemorrhage (IPH) have an increased risk of recurrent ipsilateral ischemic cerebrovascular events. It was previously reported that symptomatic carotid plaques with IPH showed higher IPH signal intensity ratios (SIR) and larger IPH volumes than asymptomatic plaques. We explored whether IPH SIR and IPH volume are associated with future ipsilateral ischemic cerebrovascular events beyond the presence of IPH.

Methods: Transient ischemic attack and ischemic stroke patients with mild-to-moderate carotid stenosis and an ipsilateral IPH-positive carotid plaque (n = 89) from the PARISK study were included. The clinical endpoint was a new ipsilateral ischemic cerebrovascular event during 5 years of follow-up, while the imaging-based endpoint was a new ipsilateral brain infarct on brain magnetic resonance imaging (MRI) after 2 years (n = 69). Trained observers delineated IPH, a hyperintense region compared to surrounding muscle tissue on hyper T1-weighted magnetic resonance images. The IPH SIR was the maximal signal intensity in the IPH region divided by the mean signal intensity of adjacent muscle tissue. The associations between IPH SIR or volume and the clinical and imaging-based endpoint were investigated using Cox proportional hazard models and logistic regression, respectively.

Results: During 5.1 (interquartile range: 3.1-5.6) years of follow-up, 21 ipsilateral cerebrovascular ischemic events were identified. Twelve new ipsilateral brain infarcts were identified on the 2-year neuro MRI. There was no association for IPH SIR or IPH volume with the clinical endpoint (hazard ratio (HR): 0.89 [95% confidence interval: 0.67-1.10] and HR: 0.91 [0.69-1.19] per 100-µL increase, respectively) nor with the imaging-based endpoint (odds ratio (OR): 1.04 [0.75-1.45] and OR: 1.21 [0.87-1.68] per 100-µL increase, respectively).

Conclusion: IPH SIR and IPH volume were not associated with future ipsilateral ischemic cerebrovascular events. Therefore, quantitative assessment of IPH of SIR and volume does not seem to provide additional value beyond the presence of IPH for stroke risk assessment.

Trial registration: The PARISK study was registered on ClinicalTrials.gov with ID NCT01208025 on September 21, 2010 (https://clinicaltrials.gov/study/NCT01208025).

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核磁共振成像上颈动脉斑块内出血的信号强度和体积与同侧脑血管事件的风险:Plaque At RISK (PARISK) 研究。
研究背景风险斑块(PARISK)研究表明,颈动脉斑块伴斑块内出血(IPH)的患者复发同侧缺血性脑血管事件的风险增加。之前有报道称,与无症状斑块相比,有症状的颈动脉斑块伴有 IPH 表现出更高的 IPH 信号强度比(SIR)和更大的 IPH 体积。我们探讨了IPH信号强度比(SIR)和IPH体积是否与未来同侧缺血性脑血管事件相关,而不仅仅是IPH的存在:方法:纳入 PARISK 研究中轻度至中度颈动脉狭窄、同侧 IPH 阳性颈动脉斑块的 TIA 和缺血性脑卒中患者(89 人)。临床终点是随访5年期间出现新的同侧缺血性脑血管事件,而影像学终点是2年后脑部核磁共振成像出现新的同侧脑梗塞(69人)。训练有素的观察者在超 T1 加权磁共振图像上划分出 IPH,即与周围肌肉组织相比呈高密度的区域。IPH SIR 是 IPH 区域的最大信号强度除以邻近肌肉组织的平均信号强度。研究人员分别使用 Cox 比例危险模型和逻辑回归法研究了 IPH SIR 或体积与临床终点和影像学终点之间的关系:在5.1年(四分位数间距(IQR):3.1-5.6)的随访期间,共发现21例同侧脑血管缺血事件。在为期两年的神经磁共振成像中发现了12例新的同侧脑梗塞。IPH SIR或IPH体积与临床终点(每增加100µl分别为HR:0.89 [95% CI:0.67-1.10]和HR:0.91 [0.69-1.19])和影像学终点(每增加100µl分别为OR:1.04 [0.75-1.45]和OR:1.21 [0.87-1.68])均无关联:结论:IPH SIR 和 IPH 容量与未来同侧缺血性脑血管事件无关。因此,对 IPH 的定量评估似乎并不能为卒中风险评估提供 IPH 存在之外的额外价值。试验注册 PARISK研究于2010年9月21日在ClinicalTrials.gov上注册,ID为NCT01208025(https://clinicaltrials.gov/study/NCT01208025)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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