High-resolution MRIによるcarotid plaque volumeの評価
背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術 (CEA) の有効性も明らかではない. しかしながら, こうした病変の中には, 比較的厚いplaque volumeを有した病変も存在する. 今回われわれは, high-resolution MRIを用いてplaque volumeを定量的に算出し, 病理所見や背景因子と比較し, plaque volume測定の意義を検討した. 方法 2003年4月より2005年10月までの間で, 本疾患に対してCEAを施行した連続22症例22病変を対象とし, PDWI...
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| Published in | 脳卒中 Vol. 29; no. 1; pp. 29 - 37 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
2007
日本脳卒中学会 |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.29.29 |
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| Abstract | 背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術 (CEA) の有効性も明らかではない. しかしながら, こうした病変の中には, 比較的厚いplaque volumeを有した病変も存在する. 今回われわれは, high-resolution MRIを用いてplaque volumeを定量的に算出し, 病理所見や背景因子と比較し, plaque volume測定の意義を検討した. 方法 2003年4月より2005年10月までの間で, 本疾患に対してCEAを施行した連続22症例22病変を対象とし, PDWIをもとにplaque volumeを定量的に算出した. そして, これらの結果と臨床データとの統計学的解析を行った. 結果 平均plaque volumeは, 無症候性8病変で1,154.0±666.2mm3, 症候性14病変で983.9±349.4mm3と有意に無症候性で高値を呈した (p=0.02). 無症候性病変の中には, plaque内出血を合併した病変が多く見られた. 結論 plaque volumeの増大には, 新生血管とplaque内出血が深く関与しており, それは動脈硬化進行度そのものを表しているものと考えられた. 本疾患においては, その狭窄度だけではなく, plaqueの性状, plaque volumeも考慮し治療へのアプローチを図る必要性がある. |
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| AbstractList | 背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術 (CEA) の有効性も明らかではない. しかしながら, こうした病変の中には, 比較的厚いplaque volumeを有した病変も存在する. 今回われわれは, high-resolution MRIを用いてplaque volumeを定量的に算出し, 病理所見や背景因子と比較し, plaque volume測定の意義を検討した. 方法 2003年4月より2005年10月までの間で, 本疾患に対してCEAを施行した連続22症例22病変を対象とし, PDWIをもとにplaque volumeを定量的に算出した. そして, これらの結果と臨床データとの統計学的解析を行った. 結果 平均plaque volumeは, 無症候性8病変で1,154.0±666.2mm3, 症候性14病変で983.9±349.4mm3と有意に無症候性で高値を呈した (p=0.02). 無症候性病変の中には, plaque内出血を合併した病変が多く見られた. 結論 plaque volumeの増大には, 新生血管とplaque内出血が深く関与しており, それは動脈硬化進行度そのものを表しているものと考えられた. 本疾患においては, その狭窄度だけではなく, plaqueの性状, plaque volumeも考慮し治療へのアプローチを図る必要性がある. 要旨：背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術(CEA)の有効性も明らかではない. しかしながら, こうした病変の中には, 比較的厚いplaque volurneを有した病変も存在する, 今回われわれは, high-resolution MRIを用いてplaque volumeを定量的に算出し, 病理所見や背景因子と比較し, plaque volume測定の意義を検討した. 方法 2003年4月より2005年10月までの間で, 本疾患に対してCEAを施行した連続22症例22病変を対象とし, PDWIをもとにplaque volumeを定量的に算出した. そして, これらの結果と臨床データとの統計学的解析を行った. 結果 平均plaque volumeは, 無症候性8病変で1,154.0±666.2mm3, 症候性14病変で983.9±3494mm3と有意に無症候性で高値を呈した(p=0.02). 無症候性病変の中には, plaque内出血を合併した病変が多く見られた. 結論 plaque volumeの増大には, 新生血管とplaque内出血が深く関与しており, それは動脈硬化進行度そのものを表しているものと考えられた. 本疾患においては, その狭窄度だけではなく, plaqueの性状, plaque volumeも考慮し治療へのアプローチを図る必要性がある. |
| Author | 堤, 圭介 永田, 泉 北川, 直毅 川原, 一郎 森川, 実 中本, 守人 |
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| DOI | 10.3995/jstroke.29.29 |
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| References | 16) Group, European Carotid Surgery Trialists' Collaborative: MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group. Lancet 337: 1235-1243, 1991 14) Zhang S, Cai J, Luo Y, et al: Measurement of carotid wall volume and maximum area with contrast-enhanced 3D MR imaging: initial observations. Radiology 228: 200-205, 2003 17) Moore WS, Barnett HJ, Beebe HG, et al: Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. Stroke 26: 188-201, 1995 12) Varghese A, Crowe LA, Mohiaddin RH, et al: Inter-study reproducibility of 3D volume selective fast spin echo sequence for quantifying carotid artery wall volume in asymptomatic subjects. Atherosclerosis 183: 361-366, 2005 6) Ross R: Atherosclerosis is an inflammatory disease. Am Heart J 138: S419-420, 1999 15) Collaborators, North American Symptomatic Carotid Endarterectomy Trial: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325: 445-453, 1991 9) Touboul PJ, Labreuche J, Vicaut E, et al: Carotid intima-media thickness, plaques, and Framingham risk score as independent determinants of stroke risk. Stroke 36: 1741-1745, 2005 13) Varghese A, Crowe LA, Mohiaddin RH, et al: Interstudy reproducibility of three-dimensional volume-selective fast spin echo magnetic resonance for quantifying carotid artery wall volume. J Magn Reson Imaging 21: 187-191, 2005 8) Nagai Y, Kitagawa K, Yamagami H, et al: Carotid artery intima-media thickness and plaque score for the risk assessment of stroke subtypes. Ultrasound Med Biol 28: 1239-1243, 2002 24) Schmitz SA, Taupitz M, Wagner S, et al: Magnetic resonance imaging of atherosclerotic plaques using superparamagnetic iron oxide particles. J Magn Reson Imaging 14: 355-361, 2001 25) Sirol M, Aguinaldo JG, Graham PB, et al: Fibrin-targeted contrast agent for improvement of in vivo acute thrombus detection with magnetic resonance imaging. Atherosclerosis 182: 79-85, 2005 7) Wasserman BA, Wityk RJ, Trout HH 3rd, et al: Low-grade carotid stenosis: looking beyond the lumen with MRI. Stroke 36: 2504-2513, 2005 19) Kolodgie FD, Gold HK, Burke AP, et al: Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349: 2316-2325, 2003 23) Kooi ME, Cappendijk VC, Cleutjens KB, et al: Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaques can be detected by in vivo magnetic resonance imaging. Circulation 107: 2453-2458, 2003 11) Kawahara I, Honda M, Junichi K, et al: Comparison of carotid ultrasonography and high-resolution MRI for detecting soft plaque. Neurosonology 18: 69-73, 2005 3) Bassiouny HS, Sakaguchi Y, Mikucki SA, et al: Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. J Vasc Surg 26: 585-594, 1997 27) Imparato AM, Giangola G: The carotid bifurcation plaque and carotid endarterectomy. Carotid artery surgery. New York, Thieme Medical Publishers., 2000, (Chapter 5 5) Fayad ZA, Fuster V: Clinical imaging of the highrisk or vulnerable atherosclerotic plaque. Circ Res 89: 305-316, 2001 18) Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 92: 657-671, 1995 21) Hansson GK, Libby P, Schonbeck U, et al: Innate and adaptive immunity in the pathogenesis of atherosclerosis. Circ Res 91: 281-291, 2002 1) Gillard JH: Imaging of carotid artery disease: from luminology to function? Neuroradiology 45: 671-680, 2003 28) Crisby M, Nordin-Fredriksson G, Shah PK, et al: Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation 103: 926-933, 2001 20) Glagov S, Weisenberg E, Zarins CK, et al: Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316: 1371-1375, 1987 4) Carr S, Farb A, Pearce WH, et al: Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg 23: 755-765, discussion 765-766, 1996 22) Cai JM, Hatsukami TS, Ferguson MS, et al: Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106: 1368-1373, 2002 2) Yuan C, Mitsumori LM, Beach KW, et al: Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology 221: 285-299, 2001 10) Honda M, Kitagawa N, Tsutsumi K, et al: High-resolution magnetic resonance imaging for detection of carotid plaques. Neurosurgery 58: 338-346,; discussion 338-346,, 2006 26) Yuan C, Kerwin WS, Ferguson MS, et al: Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization. J Magn Reson Imaging 15: 62-67, 2002 |
| References_xml | – reference: 5) Fayad ZA, Fuster V: Clinical imaging of the highrisk or vulnerable atherosclerotic plaque. Circ Res 89: 305-316, 2001 – reference: 10) Honda M, Kitagawa N, Tsutsumi K, et al: High-resolution magnetic resonance imaging for detection of carotid plaques. Neurosurgery 58: 338-346,; discussion 338-346,, 2006 – reference: 8) Nagai Y, Kitagawa K, Yamagami H, et al: Carotid artery intima-media thickness and plaque score for the risk assessment of stroke subtypes. Ultrasound Med Biol 28: 1239-1243, 2002 – reference: 9) Touboul PJ, Labreuche J, Vicaut E, et al: Carotid intima-media thickness, plaques, and Framingham risk score as independent determinants of stroke risk. Stroke 36: 1741-1745, 2005 – reference: 23) Kooi ME, Cappendijk VC, Cleutjens KB, et al: Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaques can be detected by in vivo magnetic resonance imaging. Circulation 107: 2453-2458, 2003 – reference: 6) Ross R: Atherosclerosis is an inflammatory disease. Am Heart J 138: S419-420, 1999 – reference: 28) Crisby M, Nordin-Fredriksson G, Shah PK, et al: Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation 103: 926-933, 2001 – reference: 13) Varghese A, Crowe LA, Mohiaddin RH, et al: Interstudy reproducibility of three-dimensional volume-selective fast spin echo magnetic resonance for quantifying carotid artery wall volume. J Magn Reson Imaging 21: 187-191, 2005 – reference: 18) Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 92: 657-671, 1995 – reference: 22) Cai JM, Hatsukami TS, Ferguson MS, et al: Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106: 1368-1373, 2002 – reference: 19) Kolodgie FD, Gold HK, Burke AP, et al: Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349: 2316-2325, 2003 – reference: 7) Wasserman BA, Wityk RJ, Trout HH 3rd, et al: Low-grade carotid stenosis: looking beyond the lumen with MRI. Stroke 36: 2504-2513, 2005 – reference: 20) Glagov S, Weisenberg E, Zarins CK, et al: Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316: 1371-1375, 1987 – reference: 27) Imparato AM, Giangola G: The carotid bifurcation plaque and carotid endarterectomy. Carotid artery surgery. New York, Thieme Medical Publishers., 2000, (Chapter 5) – reference: 11) Kawahara I, Honda M, Junichi K, et al: Comparison of carotid ultrasonography and high-resolution MRI for detecting soft plaque. Neurosonology 18: 69-73, 2005 – reference: 15) Collaborators, North American Symptomatic Carotid Endarterectomy Trial: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325: 445-453, 1991 – reference: 17) Moore WS, Barnett HJ, Beebe HG, et al: Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. Stroke 26: 188-201, 1995 – reference: 14) Zhang S, Cai J, Luo Y, et al: Measurement of carotid wall volume and maximum area with contrast-enhanced 3D MR imaging: initial observations. Radiology 228: 200-205, 2003 – reference: 26) Yuan C, Kerwin WS, Ferguson MS, et al: Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization. J Magn Reson Imaging 15: 62-67, 2002 – reference: 3) Bassiouny HS, Sakaguchi Y, Mikucki SA, et al: Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. J Vasc Surg 26: 585-594, 1997 – reference: 16) Group, European Carotid Surgery Trialists' Collaborative: MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group. Lancet 337: 1235-1243, 1991 – reference: 25) Sirol M, Aguinaldo JG, Graham PB, et al: Fibrin-targeted contrast agent for improvement of in vivo acute thrombus detection with magnetic resonance imaging. Atherosclerosis 182: 79-85, 2005 – reference: 1) Gillard JH: Imaging of carotid artery disease: from luminology to function? Neuroradiology 45: 671-680, 2003 – reference: 2) Yuan C, Mitsumori LM, Beach KW, et al: Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology 221: 285-299, 2001 – reference: 12) Varghese A, Crowe LA, Mohiaddin RH, et al: Inter-study reproducibility of 3D volume selective fast spin echo sequence for quantifying carotid artery wall volume in asymptomatic subjects. Atherosclerosis 183: 361-366, 2005 – reference: 21) Hansson GK, Libby P, Schonbeck U, et al: Innate and adaptive immunity in the pathogenesis of atherosclerosis. Circ Res 91: 281-291, 2002 – reference: 4) Carr S, Farb A, Pearce WH, et al: Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg 23: 755-765, discussion 765-766, 1996 – reference: 24) Schmitz SA, Taupitz M, Wagner S, et al: Magnetic resonance imaging of atherosclerotic plaques using superparamagnetic iron oxide particles. J Magn Reson Imaging 14: 355-361, 2001 |
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| Snippet | 背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術 (CEA) の有効性も... 要旨：背景及び目的 頸部頸動脈狭窄症においては, 中等度狭窄病変による虚血性イベントの危険性は十分には解明されておらず, また, 頸動脈内膜剥離術(CEA)の有効性も... |
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| Title | High-resolution MRIによるcarotid plaque volumeの評価 |
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