| 罗六一,孙文,鲁亚楠,等.5.0 T高分辨磁共振血管壁成像用于慢性颈内动脉闭塞介入再通术前评估的价值[J].中国临床保健杂志,2026,29(3):310-316. |
| 5.0 T高分辨磁共振血管壁成像用于慢性颈内动脉闭塞介入再通术前评估的价值 |
| Clinical value of 5.0 T high-resolution magnetic resonance vessel wall imaging in the preoperative prediction of endovascular recanalization for chronic internal carotid artery occlusion |
| 投稿时间：2026-04-29 |
| DOI：10.3969/J.issn.1672-6790.2026.03.004 |
| 中文关键词: 磁共振血管造影术 颈动脉疾病 血管内操作 预测 |
| 英文关键词: Magnetic resonance angiography Carotid artery diseases Endovascular procedures Forecasting Fund program:National Natural Science Foundation of China |
| 基金项目:国家自然科学基金项目 |
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| 中文摘要: |
| 目的 探讨5.0 T高分辨磁共振血管壁成像(HR-VWI)在症状性慢性颈内动脉闭塞(sCICAO)介入再通术前评估的临床应用价值。方法 回顾性分析2023年1月至2025年12月于中国科学技术大学附属第一医院(安徽省立医院)接受颈内动脉闭塞介入再通治疗患者的临床和影像学数据,所有患者术前均完成5.0 T HR-VWI及数字减影血管造影(DSA)检查。由两名经验丰富的影像科医师采用结局设盲法独立评估闭塞段结构、斑块特征、钙化及微通道等指标,分析上述指标与介入成功再通及围手术期并发症的关系。结果 共纳入47例患者,手术成功再通34例(成功组,72.3%),失败13例(失败组,27.7%)；围手术期严重并发症2例(4.3%)。成功组微通道(97.1%比38.5%)、闭塞长度≤15 mm(73.5%比30.8%)、无环形钙化(88.2%比30.8%)及斑块显著强化(61.8%比23.1%)的比例均显著高于失败组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,微通道(OR=14.02,95%CI:1.93~101.74,P<0.05)、闭塞长度≤15 mm(OR=7.64,95%CI:1.36~42.81,P<0.05)、无环形钙化(OR=10.13,95%CI:1.54~66.29,P<0.05)、斑块显著强化(OR=5.12,95%CI:1.06~24.87,P<0.05)为成功再通独立预测因素。基于上述4项指标构建的手术成功预测模型,曲线下面积(AUC)为0.924(95%CI:0.851~0.997,P<0.001)。围手术期严重并发症患者中斑块内出血合并纤维帽不完整的检出率为100%(2/2),显著高于无并发症患者的17.8%(8/45),差异有统计学意义(P<0.05)。结论 5.0 T HR-VWI可清晰显示sCICAO闭塞段结构特征,有助于筛选介入治疗的最适人群,评估围手术期并发症风险。 |
| 英文摘要: |
| Objective To evaluate the clinical value of 5.0 T high-resolution magnetic resonance vessel wall imaging (HR-VWI) in the preoperative evaluation and prediction of endovascular recanalization for symptomatic chronic internal carotid artery occlusion (sCICAO).Methods The clinical and neuroradiological data of 47 patients with sCICAO who underwent endovascular recanalization at the First Affiliated Hospital of University of Science and Technology of China from January 2023 to December 2025 were retrospectively analyzed.All patients completed preoperative 5.0 T HR-VWI and digital subtraction angiography (DSA).Two experienced radiologists independently evaluated the occluded segment morphology,plaque features,calcification distribution,and microchannels using an outcome-blinded method.The correlations between these imaging signs and technical success or perioperative complications were analyzed.Results Among the 47 patients,technical recanalization was successful in 34 cases (72.3%) and failed in 13 cases (27.7%).Severe perioperative complications occurred in 2 cases (4.3%).Univariable analysis revealed that the detection rates of microchannels (97.1% vs 38.5%),occlusion length ≤15 mm (73.5% vs 30.8%),absence of circumferential calcification (88.2% vs 30.8%),and prominent plaque enhancement (61.8% vs 23.1%) were significantly higher in the successful recanalization group than in the failure group (P<0.05).Multivariable logistic regression analysis demonstrated that microchannels (OR=14.02,95%CI:1.93-101.74,P<0.05),occlusion length ≤15 mm (OR=7.64,95%CI:1.36-42.81,P<0.05),absence of circumferential calcification (OR=10.13,95%CI:1.54-66.29,P<0.05),and prominent plaque enhancement (OR=5.12,95%CI:1.06-24.87,P<0.05) were independent predictors of successful technical recanalization.The joint predictive model constructed using these four metrics achieved an area under the ROC curve (AUC) of 0.924 (95%CI:0.851-0.997,P<0.001).Furthermore,the detection rate of intraplaque hemorrhage concomitant with an incomplete fibrous cap was significantly higher in patients with severe perioperative complications than in those without (100% vs 17.8%,P<0.05).Conclusions 5.0 T HR-VWI can clearly display the structural characteristics of the occluded segment in sCICAO,which helps to select the optimal candidates for interventional therapy and evaluate perioperative risks. |
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