282例颈动脉钙化与脑小血管病MRI总负荷评分的关联性

doi:10.6040/j.issn.1671-7554.0.2022.1150

摘要/Abstract

摘要： 目的探讨颈动脉钙化与脑小血管病(CSVD)MRI总负荷评分的关联性。方法回顾性分析2020年1月至2022年1月行颈动脉CTA和颅脑MRI检查的282例CSVD患者的相关资料,评估颈动脉钙化情况(有无钙化、数目、位置、形态和环征)和CSVD总负荷评分(包括腔隙、脑白质高信号、微出血、血管周围间隙扩大)。应用有序多分类Logistic回归分析明确颈动脉钙化与CSVD总负荷的关联性。结果共125例(44.3%)患者存在颈动脉钙化,随着颈动脉钙化发生率增加,CSVD总负荷评分增高,差异有统计学意义(χ2=13.814,P=0.003),不同CSVD总负荷组的钙化数目(χ2=16.754,P=0.010)、钙化位置(χ2=17.776,P=0.007)、钙化形态(χ2=28.943,P<0.001)存在统计学差异,而环征在各组间差异无统计学意义(χ2=4.867,P=0.182)。CSVD 3+组的多发钙化、表面钙化、厚钙化/混合钙化的发生率较CSVD 0组增加。校正年龄、性别、高血压、糖尿病、高血脂、颈动脉狭窄程度、重构指数后,颈动脉钙化是CSVD总负荷的独立危险因素(OR=3.687,95%CI:1.013~13.423,P=0.048)。结论颈动脉钙化与CSVD总负荷密切相关,可作为CSVD严重程度的预测指标,为CSVD患者的临床防治提供依据。

关键词: 颈动脉钙化, 脑小血管病, 磁共振成像, 体层摄影术,X线计算机, 血管造影术

Abstract: Objective To investigate the association between carotid calcification and total burden of cerebral small vessel disease(CSVD). Methods Clinical data of 282 CSVD patients who underwent both computed tomography angiography(CTA)and magnetic resonance imaging(MRI)during Jan. 2020 and Jan. 2022 were retrospectively analyzed. Characteristics of carotid calcification(presence, size, number, location, and rim sign)and CSVD total burden(lacunes, white matter hyperintensities, microbleeds, enlarged perivascular space)were assessed. The association between carotid calcification and total burden of CSVD was determined with ordinal multivariable logistic regression. Results Carotid calcification was detected in 125(44.3%)patients. The total burden of CSVD rose significantly with the increasing incidence of carotid calcification(χ2=13.814, P=0.003). There were significant differences in the number(χ2=16.754, P=0.010), location(χ2=17.776, P=0.007)and size(χ2=28.943, P<0.001)of calcification in different CSVD total burden groups, while no significant difference was discovered in rim sign(χ2=4.867, P=0.182). Compared with CSVD 0 group, CSVD 3+ group showed higher incidences of multiple, surface and thick/mixed calcifications. After age, gender, hypertension, diabetes, hyperlipidemia and carotid artery stenosis were adjusted and indexes were remodeled, carotid calcification was an independent risk factor for CSVD total burden(OR=3.687, 95%CI: 1.013-13.423, P=0.048). Conclusion Carotid calcification is closely related to the CSVD total burden, which can act as a potential predictor of the severity of CSVD and help the clinical prevention and treatment.

Key words: Carotid calcification, Cerebral small vessel diseases, Magnetic resonance imaging, Tomography, X-ray computed, Angiography

中图分类号:

R445.2

赵恩举,赵硕,郭云亮,王锡明. 282例颈动脉钙化与脑小血管病MRI总负荷评分的关联性[J]. 山东大学学报 (医学版), 2023, 61(1): 38-44.

ZHAO Enju, ZHAO Shuo, GUO Yunliang, WANG Ximing. Association between carotid calcification and MRI overall burden in 282 cases of cerebral small vessel disease[J]. Journal of Shandong University (Health Sciences), 2023, 61(1): 38-44.

参考文献

[1] 中国研究型医院学会脑小血管病专业委员会《中国脑小血管病诊治专家共识》编写组.中国脑小血管病诊治专家共识2021[J]. 中国卒中杂志, 2021, 16(7): 716-726.
[2] 唐若楠, 邢晓娜, 陈晓虹. 脑小血管病影像学标志物总负荷评估及其应用[J]. 中华神经科杂志, 2019, 52(2): 136-142. TANG Ruonan, XING Xiaona, CHEN Xiaohong. Evaluation of total burden of imaging markers for small cerebral vascular diseases and its application [J]. Chinese Journal of Neurology, 2019, 52(2): 136-142.
[3] Gong L, Wang H, Dong Q, et al. Intracranial atherosclerotic stenosis is related to post-stroke cognitive impairment: a crosssectional study of minor stroke [J]. Curr Alzheimer Res, 2020, 17(2): 177-184.
[4] Del Brutto OH, Mera RM, Gillman J, et al. Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community-dwelling older adults: a population-based study in rural Ecuador [J]. Geriatr Gerontol Int, 2016, 16(9): 1063-1067.
[5] Tao XX, Li GF, Wu YL, et al. Relationship between intracranial internal carotid artery calcification and enlarged cerebral perivascular space [J]. Neuroradiology, 2017, 59(5): 577-586.
[6] Yang J, Pan X, Zhang B, et al. Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque [J]. Eur Radiol, 2018, 28(12): 4968-4977.
[7] Lin R, Chen S, Liu G, et al. Association between carotid atherosclerotic plaque calcification and intraplaque hemorrhage: a magnetic resonance imaging study [J]. Arterioscler Thromb Vasc Biol, 2017, 37(6): 1228-1233.
[8] Benson JC, Nardi V, Madhavan AA, et al. Reassessing the Carotid Artery Plaque "Rim Sign" on CTA: a new analysis with histopathologic confirmation [J]. Am J Neuroradiol, 2022, 43(3): 429-434.
[9] North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress [J]. Stroke, 1991, 22(6): 711-720.
[10] van Veelen A, van der Sangen NMR, Delewi R, et al. Detection of vulnerable coronary plaques using invasive and non-invasive imaging modalities [J]. J Clin Med, 2022, 11(5): 1361. doi:10.3390/jcm11051361.
[11] Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration [J]. Lancet Neurol, 2013, 12(8): 822-838.
[12] Chen X, Wang J, Shan Y, et al. Cerebral small vessel disease: neuroimaging markers and clinical implication [J]. J Neurol, 2019, 266(10): 2347-2362.
[13] Guo Y, Zhao S, Hou X, et al. Insidious Attentional Deficits in Patients with Cerebral Small Vessel Disease Revealed by Attention Network Test [J]. Front Neurol, 2022, 13: 865307. doi:10.3389/fneur.2022.865307.
[14] Charidimou A, Boulouis G, Pasi M, et al. MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy [J]. Neurology, 2017, 88(12): 1157-1164.
[15] Pasi M, Sugita L, Xiong L, et al. Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage [J]. Neurology, 2021, 96(2): e182-e192.
[16] Hilal S, Mok V, Youn YC, et al. Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries [J]. J Neurol Neurosurg Psychiatry, 2017, 88(8): 669-674.
[17] Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications [J]. Lancet Neurol, 2019, 18(7): 684-696.
[18] Han F, Zhang DD, Zhai FF, et al. Association between large artery stenosis, cerebral small vessel disease and risk of ischemic stroke [J]. Sci China Life Sci, 2021, 64(9): 1473-1480.
[19] Tarumi T, Ayaz Khan M, Liu J, et al. Cerebral hemodynamics in normal aging: central artery stiffness, wave reflection, and pressure pulsatility [J]. J Cereb Blood Flow Metab, 2014, 34(6): 971-978.
[20] Wang Y, Li C, Ding M, et al. Carotid atherosclerotic calcification characteristics relate to post-stroke cognitive impairment [J]. Front Aging Neurosci, 2021, 13: 682908. doi: 10.3389/fnagi.2021.682908. doi:10.3389/fnagi.2021.682908.
[21] Cardoso L, Kelly-Arnold A, Maldonado N, et al. Effect of tissue properties, shape and orientation of microcalcifications on vulnerable cap stability using different hyperelastic constitutive models [J]. J Biomech, 2014, 47(4): 870-877.
[22] Alfonso F, Gonzalo N, Nuñez-Gil I, et al. Coronary thrombosis from large, nonprotruding, superficial calcified coronary plaques [J]. J Am Coll Cardiol, 2013, 62(23): 2254. doi:10.1016/j.jacc.2013.04.106.
[23] Xu X, Hua Y, Liu B, et al. Correlation between calcification characteristics of carotid atherosclerotic plaque and plaque vulnerability [J]. Ther Clin Risk Manag, 2021, 17: 679-690. doi:10.2147/TCRM.S303185.
[24] Kan Y, He W, Ning B, et al. The correlation between calcification in carotid plaque and stroke: calcification may be a risk factor for stroke [J]. Int J Clin Exp Pathol, 2019, 12(3): 750-758.
[25] Zhang J, Wang Z, Zhou M, et al. Association between asymptomatic vulnerable carotid plaques and cognitive impairment in rural adults [J]. Front Neurol, 2020, 11:662. doi:10.3389/fneur.2020.00662.
[26] Kidwell CS, Rosand J, Norato G, et al. Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage [J]. Neurology, 2017, 88(8): 782-788.
[27] Zhu R, Li Y, Chen L, et al. Total burden of cerebral small vessel disease on MRI may predict cognitive impairment in parkinsons disease [J]. J Clin Med, 2022, 11(18): 5381. doi:10.3390/jcm11185381.
[28] Jiménez-Balado J, Riba-Llena I, Abril O, et al. Cognitive impact of cerebral small vessel disease changes in patients with hypertension [J]. Hypertension, 2019, 73(2): 342-349.

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