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目的 探讨颅内动脉与颈动脉并存斑块分布特征对卒中复发风险的预测价值。 方法 连续纳入2周内发生缺血性卒中且至少一侧颈动脉存在粥样硬化斑块的患者，于基线期进行颅外颈动脉多对比度MR血管壁成像和颅内动脉MRA检查。随后对所有患者进行至少1年的随访研究，观察有无缺血性卒中复发。分析粥样硬化斑块在颅外颈动脉不同节段的分布特征，以及前循环颅内动脉狭窄并存颅外颈动脉不同节段斑块的发生率。采用Cox回归计算前循环颅内动脉狭窄并存颈动脉不同节段斑块对缺血性卒中复发的预测价值。 结果 共纳入117例患者，平均年龄为（62.6±11.8）岁，其中男性85例，中位随访时间为12.0（11.1～12.8）个月，有31例（26.5%）患者发生缺血性卒中复发。前循环颅内动脉狭窄并存颈动脉球部斑块与卒中复发显著相关（HR 2.535，95%CI 1.085～5.922，P=0.032），校正年龄、性别、BMI混杂因素后该相关性仍具有统计学意义（HR 2.903，95%CI 1.114～7.565，P=0.029）。前循环颅内动脉狭窄并存颈动脉其他节段斑块与卒中复发无相关（P>0.05）。 结论 在缺血性卒中且至少一侧颈动脉存在粥样硬化斑块的患者中，前循环颅内动脉狭窄并存颈动脉球部斑块与卒中复发独立相关。 Abstract: Objective To investigate the predictive value of intracranial and carotid arteries coexisting atherosclerotic plaque distribution characteristics for the risk of stroke recurrence. Methods Patients with ischemic stroke within 2 weeks and at least one carotid plaque were consecutively included and underwent multi-contrast MR vessel wall imaging for extracranial carotid arteries and MRA for intracranial arteries at baseline. All patients were followed up for at least 1 year to record stroke recurrence. The distribution characteristics of atherosclerotic plaque in different segments of the extracranial carotid artery and the incidence of coexisting intracranial artery stenosis in anterior circulation and extracranial carotid artery atherosclerotic plaques in different segments were analyzed. Univariate and multivariate Cox regressions were used to calculate the predictive value of coexisting intracranial artery stenosis in anterior circulation and carotid artery atherosclerotic plaques in different segments for stroke recurrence. Results A total of 117 patients were included, with a mean age of (62.6±11.8) years, including 85 males. The median follow-up time was 12.0(11.1-12.8) months, and 31(26.5%) patients experienced stroke recurrence. Coexisting intracranial artery stenosis in the anterior circulation and atherosclerotic plaques in the segment of the carotid bulb was significantly associated with stroke recurrence (HR 2.535, 95%CI 1.085-5.922, P=0.032). After adjusting for confounding factors (age, sex, and BMI), this association remained statistically significant (HR 2.903, 95%CI 1.114-7.565, P=0.029). No significant association was found between intracranial artery stenosis in anterior circulation coexistent with atherosclerotic plaque in other segments of the carotid artery and stroke recurrence (P>0.05). Conclusions In patients with ischemic stroke and at least one carotid plaque, coexisting intracranial artery stenosis in anterior circulation and atherosclerotic plaque in the segment of the carotid bulb was independently associated with stroke recurrence.

目的 调查血压昼夜节律变化与颅内动脉粥样硬化斑块负荷及易损性的相关性。 方法 回顾性分析一个颅内动脉粥样硬化卒中影像队列中的267例卒中患者的临床及影像特征，根据24 h动态血压将其分为杓型血压组、非杓型血压组和反杓型血压组，通过高分辨磁共振血管壁成像及图像分析获得颅内动脉Willis环近端血管壁斑块特征，包括最大管壁厚度、斑块内出血、中重度狭窄（狭窄程度≥50%）、多发斑块（斑块数量≥3个）等指标。比较3组基线特征及颅内动脉粥样硬化斑块特征，校正混杂因素后，采用logistic回归分析血压昼夜节律变化模式与颅内动脉粥样硬化斑块特征的关系。 结果 杓型血压组、非杓型血压组和反杓型血压组分别有36、119及112例。①反杓型血压组年龄更大（反杓型血压组∶非杓型血压组∶杓型血压组=67.3∶64.6∶61.9岁，P=0.042），合并糖尿病比例更高（反杓型血压组∶非杓型血压组∶杓型血压组=46.4%∶41.2%∶22.2%，P=0.037）；血压指标中，反杓型血压组24 h平均收缩压更高（反杓型血压组∶非杓型血压组∶杓型血压组=144∶139∶136 mmHg，P=0.025）。②杓型血压组、非杓型血压组和反杓型血压组的平均最大管壁厚度分别为2.39 mm、2.48 mm和2.52 mm（P=0.554），斑块内出血比例分别33.3%（12/36）、36.1%（43/119）和37.5%（42/112）（P=0.901）；3组中重度狭窄及多发斑块比例差异亦无统计学意义（中重度狭窄比例在杓型血压组、非杓型血压组和反杓型血压组分别为22.2%、32.8%和37.5%，P=0.236；多发斑块比例在3组分别为63.9%、73.9%和75.0%，P=0.407）。③多因素logistic回归分析结果显示：年龄（OR 1.053，95%CI 1.027～1.080，P＜0.001）和糖尿病（OR 2.194，95%CI 1.186～4.057，P=0.012）与颅内动脉多发斑块独立相关。未发现血压昼夜节律变化模式与颅内动脉多发斑块、中重度狭窄以及斑块内出血存在相关性（均P＞0.05）。 结论 增龄和糖尿病是颅内动脉多发斑块的独立危险因素，血压昼夜节律变化与颅内动脉粥样硬化斑块易损性之间的关系还有待进一步研究。 Abstract: Objective To investigate the correlation between diurnal fluctuation of blood pressure and intracranial atherosclerotic plaque characteristics, including the atherosclerotic plaque burden and its vulnerability. Methods The clinical and imaging data of 267 stroke patients from an intracranial atherosclerotic stroke imaging cohort were included in this retrospective analysis. According to 24-hour ambulatory blood pressure fluctuation rhythm, the patients were divided as dipper, nondipper, and reverse-dipper groups. High resolution MR vessel wall imaging was used to evaluate atherosclerotic plaque burden and its vulnerability. The intracranial atherosclerotic plaque characteristics including maximum vessel wall thickness (maxWT), intraplaque hemorrhage (IPH), moderate-severe stenosis (≥50%), multiple plaques (≥3 plaques) and etc. Baseline characteristics and plaque characteristics were compared among three groups, and multivariate logistic regression analysis was used to determine the association between diurnal fluctuation pattern of blood pressure and intracranial plaque burden and vulnerability. Results There were 36, 119 and 112 patients in the dipper, non-dipper, and reverse-dipper groups, respectively. (1) The age was the eldest (the mean age: 67.3, 64.6, and 61.9 years old in reversedipper, non-dipper and dipper groups, respectively, P=0.042), the proportion of diabetes was the highest (46.4%, 41.2%, and 22.2% in reverse-dipper, non-dipper and dipper groups, respectively, P=0.037), and the mean 24-hour systolic blood pressure was the highest (144 mmHg in reversedipper group, 139 mmHg in non-dipper group, and 136 mmHg in dipper groups, respectively, P=0.025) in the reverse-dipper group among the three groups; (2) The plaque characteristics in dipper, non-dipper, and reverse-dipper groups were as follows: the maxWT was 2.39 mm, 2.48 mm and 2.52 mm, P=0.554; the prevalence of IPH was 33.3% (12/36), 36.1% (43/119) and 37.5% (42/112), P=0.901; the proportion of moderate-severe stenosis of large intracranial artery was 22.2%, 32.8%, and 37.5%, P=0.236, and the proportion of multiple plaques was 63.9%, 73.9%, and 75.0%, P=0.407; (3) the multivariate logistic regression analysis showed that elder age (OR 1.053, 95%CI 1.027-1.080, P0.05). Conclusions The increasing age and diabetes were independent predictors of multiple intracranial plaques, and the diurnal fluctuation pattern of blood pressure was no correlated with intracranial atherosclerotic plaque burden and vulnerability.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 探讨弗明汉危险评分（Framingham risk score，FRS）在无症状老年人（≥60岁）颈动脉易损斑 块筛查中的价值。 方法 根据颈动脉粥样硬化斑块的3D MR管壁成像特征，将受试者分为有易损斑块组和无易损斑 块组，计算每位受试者的FRS并比较两组之间FRS的差异。采用单因素Logistic回归，计算FRS在判别颈 动脉易损斑块时的OR 和95%CI。采用ROC曲线分析FRS对颈动脉易损斑块的判别能力，并确定合适的 截断值。 结果 共纳入134例受试者，平均年龄72.3±5.5岁，男性62例（46.3%），17例（12.7%）有颈动脉易 损斑块。有易损斑块组的FRS高于无易损斑块组[37.8%（27.4%～60.0%）vs 16.6%（8.9%～27.4%）， P =0.002]。在判别颈动脉易损斑块时，FRS每升高10%对应的OR =1.556（95%CI 1.204～2.011， P =0.001），ROC曲线下面积为0.732，当截断值FRS=20%时，敏感度和特异度分别为76.5%、59.8%。 结论 FRS可用于初步筛查无症状老年人有无颈动脉易损斑块，当FRS>20%时，需对颈动脉易损斑 块进行影像学检查及评估。 Abstract: Objective To investigate the value of Framingham risk score (FRS) in screening carotid vulnerable atherosclerotic plaques in the asymptomatic elderly (≥60 years old). Methods FRS of every subject was calculated and the MR imaging characteristics of carotid atherosclerotic plaques on 3D MR vessel wall imaging were evaluated. All patients were divided into vulnerable plaque group and non-vulnerable plaque group based on the imaging results. FRS was compared between the two groups. Univariate logistic regression was used to calculate the OR and 95%CI of FRS in determining carotid vulnerable plaques. The area under the curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the ability of FRS in assessing carotid vulnerable plaques and determine the appropriate cut-off value. Results A total of 134 subjects were included in this study, with a mean age of 72.3±5.5 years old and 62 males (46.3%). 17 cases (12.7%) had carotid vulnerable plaques. The FRS in vulnerable plaques group was significantly higher than that in non-vulnerable plaques group [37.8% (27.4%- 60.0%) vs 16.6% (8.9%-27.4%), P =0.002]. In determining carotid vulnerable plaques, the OR of FRS per an increase of 10% was 1.556 (95%CI 1.204-2.011, P =0.001). ROC curve analysis showed that the AUC of FRS in determining the carotid vulnerable plaques was 0.732, and the appropriate cut-off value of FRS was 20%, with the sensitivity of 76.5% and specificity of 59.8%. Conclusions FRS can be preliminarily used to screen carotid vulnerable plaques. An advanced imaging examination is needed to evaluate carotid vulnerable plaques for the asymptomatic elderly when FRS is higher than 20%.

【摘要】 目的 基于多对比度MRI血管壁成像技术，比较颅内动脉、颅外动脉粥样硬化斑块的特征。 方法 回顾经3D多对比度头颈联合MRI血管壁成像检查确定存在前循环症状性颅内外动脉粥样硬化斑块的患者资料。观察斑块分布情况；测量斑块负荷，包括斑块最大管壁厚度、长度、管腔狭窄程度；分析斑块内成分，包括脂质坏死核、出血、钙化，对比分析颅内动脉和颅外动脉粥样硬化斑块的影像学特征。 结果 在入组的45例患者中，共检出颅内、外动脉粥样硬化斑块203个，其中颅外动脉斑块156个（76.8%），颅内动脉斑块47个（23.2%）。颅外动脉粥样硬化斑块最大管壁厚度[（3.2±1.0）mm vs （1.9±0.4）mm，P

颅内动脉和颅外颈动脉并存粥样硬化斑块（简称并存斑块）在亚洲人群中具有较高的发 生率，其与缺血性卒中的发病风险具有显著的相关性。因此，早期识别并存斑块对于缺血性脑血管 事件的防控具有重要意义。目前，应用于并存斑块的影像学诊断方法有多种，其中高分辨率磁共振管 壁成像有广阔的应用前景。本文将主要针对并存斑块的影像学研究进展方面进行综述。 Abstract: Intra- and extracranial coexisting atherosclerotic plaques (coexisting plaques) are very common in Asian populations, which has been demonstrated to be closely related to ischemic stroke. Therefore, it is important to identify the coexisting plaques for stroke prevention. Currently many imaging modalities are applied in the diagnosis of coexisting plaques, of which highresolution magnetic resonance vessel wall imaging has showed high value in assessing coexisting plaques. The article summarized the current progress in imageology of coexisting plaques.

目的 探讨2型糖尿病患者颈动脉斑块磁共振成像（magnetic r esonance i maging，MRI）特征与相应供 血区急性脑缺血病灶形态的关系。 方法 横断面研究，入组临床急性颈内动脉供血区缺血性卒中患者，排除心源性卒中，在发病一周 内行颈动脉磁共振管壁成像（magnetic resonance vessel wall imaging，MR-VWI）检查和常规MRI [包括 磁共振血管成像（magnetic resonance angiography，MRA）和弥散加权成像（diffusion-weighted imaging， DWI）]检查，评估症状侧颈动脉斑块负荷和成分特征以及颅内外动脉管腔狭窄度，根据DWI上梗死灶 形态对急性脑缺血病灶形态和体积进行分析。 结果 共入选140例急性缺血性卒中患者，其中68例（48.6%）为2型糖尿病患者，多因素回归分析显 示2型糖尿病是症状侧颈动脉斑块富脂质核发生的独立危险因素[比值比（odds ratio，OR）3.35，95% 可信区间（confidence interval，CI）1.33～8.43]；在兼具富脂质核斑块的患者中，2型糖尿病组颈内动脉 区域急性脑缺血病灶体积（[ 15.45±8.97）ml vs（9.09±8.64）ml，P=0.011]和大穿支动脉梗死发生率 [34.0% vs 13.2%，P =0.024）]显著高于非糖尿病组。 结论 颈动脉供血区急性缺血性卒中患者中，2型糖尿病与症状侧颈动脉动脉粥样硬化斑块MRI特征， 尤其是富脂质核密切相关，且更易发生大穿支动脉的梗死，提示MR-VWI细致化分析结合糖尿病因素 有助于临床对缺血性卒中风险的分层和个体化诊治。 Abstract: Objective This study aimed to investigate the correlation between the carotid plaque magnetic resonance imaging (MRI) characteristics and acute cerebral infarction focus features in patients with type 2 diabetes mellitus (DM). Methods It was a cross section study. Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited and the cardiogenic factors were excluded. All patients underwent both carotid and brain MRI scans including magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) within 1 week of symptom onset. Ipsilateral carotid plaque morphological and compositional characteristics intracranial and extracranial carotid arteries stenosis were also determined. Acute cerebral infarction patterns and size were evaluated on DWI. Results Of the 140 patients been recruited, 68 (48.6%) patients had DM. The multivariate analysis showed that DM was found to be an independent risk factor for the presence of lipi-rich necrotic core (LRNC) plaque [odds ratio (OR) 3.35, 95% confidence interval (CI) 1.33-8.43], and type 2 DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core plaques compared with non-DM patients. Among the patients with carotid LRNC plaque on symptomatic side, larger acute cerebral infarction size and more concomitant large perforating artery infarct patterns in the internal carotid artery territory were found in DM group than those of non-DM group [(15.45±8.97) ml vs (9.09±8.64) ml, P =0.011; 34.0% vs 13.2%, P =0.024]. Conclusion This study shows that more concomitant large perforating artery infarct patterns in the internal carotid artery territory are found in the type 2 DM patients with ipsilateral carotid plaque features, particularly the LRNC, than those of non-DM patients. Quantification of the carotid plaque characteristics by MRI combined DM has the potential usefulness for stroke risk stratification and individualized diagnosis and treatment.

Copyright of Journal of Clinical Neurosurgery / Linchuang Shenjingwaike Zazhi is the property of Editorial Board of Journal of Clinical Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)