| Objective:The plaque characteristics of middle cerebral artery culprit plaque and non-culprit plaque in patients with intracranial atherosclerotic stenosis(ICAS)were compared by high-resolution magnetic resonance vessel wall imaging(HRMR-VWI).Patients with bilateral vulnerable plaques of middle cerebral artery were further screened out and the characteristics of vulnerable plaques on the culprit side and the non-culprit side were compared.Methods:A total of 90 patients with ICAS who met the inclusion criteria were enrolled from October 2019 to December 2021 in our hospital.The patients were divided into culprit plaque group(57)and non-culprit plaque group(89)according to whether there were culprit plaques in the middle cerebral artery.Further,35 patients with bilateral vulnerable plaques of middle cerebral artery were screened out and divided into the culprit plaque group and the non-culprit plaque group.Clinical baseline data were collected for all enrolled patients.All the patients in the group completed the HRMR-VWI examination based on black blood technology,and measured and analyzed the characteristics of middle cerebral artery plaques,including plaque area,stenosis rate,plaque eccentricity,normalized wall index,plaque burden,plaque surface irregularity,remodeling mode of plaque,intraplaque hemorrhage and plaque enhancement.To compare the characteristics of the culprit group and the non-culprit group respectively,besides,multivariate logistic regression analysis was performed for the variables with statistical differences.Results:(1)Compared with the non-culprit plaques,the stenosis rate in the culprit plaque group was higher(0.45±0.22 VS 0.34±0.21,P=0.002)、plaque area(10.51±3.31 VS 9.23±2.60 mm~2,P=0.023)、normalized wall index(0.85±0.08 VS 0.80±0.07,P<0.001)and the plaque burden(0.81±0.11 VS 0.74±0.11,P<0.001)were larger.(2)The distributions of plaque enhancement and remodeling pattern between the culprit and non-culprit plaque groups were statistically different.The proportion of positive remodeling plaque in the culprit plaque group was higher than that in the non-culprit plaque group(59.65%VS 33.33%,P=0.014),and proportion of grade 2 enhancement plaque was higher in the non-culprit plaque group(28.07%VS 7.78%,P<0.001).(3)For the patients with bilateral vulnerable plaques of middle cerebral artery,the plaque area(11.08±3.17 VS 9.78±3.07mm~2,P=0.029),the stenosis rate(0.43±0.20 vs 0.31±0.20,P=0.025),normalized wall index(0.84±0.07 VS 0.81±0.07,P=0.031)and plaque burden(0.80±0.09 VS 0.76±0.10,P=0.046)in the culprit plaque group were higher than those of the non-culprit plaque group.Besides,there were significant differences in the distribution of plaque surface irregularity between the culprit vulnerable plaque group and the non-culprit vulnerable plaque group(54.29%VS 20.00%,P=0.012).(4)After multivariate logistic regression analysis,the differences of plaque area(OR:1.309,95%CI:1.025-1.671,P=0.031)and plaque surface irregularity(OR:5.265,95%CI:1.242-22.324,P=0.024)on the culprit side and the non-culprit side of patients with bil ateral vulnerable plaques of middle cerebral artery were still statistically significant.Conclusion:HRMR-VWI can effectively identify the high-risk features of intracranial culprit plaques.Compared with non-culprit plaques,culprit plaques have larger normalized wall index、plaque area and plaque burden,and the proportion of positive remodeling and significantly enhanced plaques was higher.In patients with bilateral vulnerable plaques of middle cerebral artery,plaque burden,plaque area,normalized wall index,stenosis rate and plaque surface irregularity of the vulnerable plaques are related to cerebrovascular events,which can provide effective basis for danger stratification. |
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