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BRAIN and NERVE Volume 65, Issue 1 （January 2013）

BRAIN and NERVE 65巻1号（2013年1月発行）

Japanese English

症例報告

頸動脈内膜剝離術後再狭窄例における術前および再狭窄時の頸動脈MRI所見（3例報告) Carotid MRI of Initial and Recurrent Plaques in Patients with Restenosis after Endarterectomy: Three Case Reports 遠藤英樹 ¹ , 上山憲司 ¹ , 高平一樹 ¹ , 荻野達也 ¹ , 髙田英和 ¹ , 片岡丈人 ¹ , 瓢子敏夫 ¹ , 中川原譲二 ¹ , 尾野英俊 ² , 中村博彦 ¹ Hideki Endo ¹ , Kenji Kamiyama ¹ , Kazuki Takahira ¹ , Tatsuya Ogino ¹ , Hidekazu Takada ¹ , Taketo Kataoka ¹ , Toshio Hyogo ¹ , Jyoji Nakagawara ¹ , Hidetoshi Ono ² , Hirohiko Nakamura ¹ ¹中村記念病院脳神経外科 ²中村記念病院放射線科 ¹Department of Neurosurgery, Nakamura Memorial Hospital ²Department of Radiology, Nakamura Memorial Hospital キーワード： Carotid black-blood MRI , Restenosis , Carotid plaque , Carotid endarterectomy Keyword: Carotid black-blood MRI , Restenosis , Carotid plaque , Carotid endarterectomy pp.93-97

発行日 2013年1月1日 Published Date 2013/1/1

DOI https://doi.org/10.11477/mf.1416101399

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参考文献 Reference

はじめに

　頸部頸動脈狭窄症の評価において，頸動脈MRI（magnetic resonance imaging）の有用性が多数報告されている^1-4)。しかしながら，術後再狭窄例に関する報告はない。頸動脈内膜剝離術（carotid endarterectomy：CEA）後再狭窄に対して頸動脈ステント留置術（carotid artery stenting：CAS）を施行した3症例において，術前病変および再狭窄病変の頸動脈MRI所見（信号強度パターン，形態）を評価・検討したので報告する。

Abstract

　Restenosis after carotid endarterectomy (CEA) is one of most significant complications. There is no previous report about MRI findings of restenotic lesions and preoperative plaques. The purpose of this study was to evaluate the initial and recurrent plaques in patients with restenosis after CEA by using black-blood MRI (BB-MRI).

　Three patients who underwent carotid artery stenting for restenosis after CEA were included in this study. The relative signal intensities (rSI) of the initial and recurrent plaques were calculated with reference to the sternocleidomastoid muscle on T₁-weighted images (T₁WI) and the submandibular gland on T₂-weighted images (T₂WI). This study investigated the rSI characteristics and morphology of the initial and recurrent plaques.

　All patients had restenosis within 1 year after CEA. The rSI values of the preoperative lesion were not high on T₁WI and were high on T₂WI in all cases (T₁WI/T₂WI: 0.63/2.43 in Case 1, 1.00/1.29 in Case 2, and 1.13/1.70 in Case 3). The morphology of the initial plaques was eccentric in 2 cases and concentric in 1 case. The rSI values of restenosis were high on T₂WI in all cases (T₁WI/T₂WI: 1.09/1.20 in Case 1, 1.31/1.50 in Case 2, and 1.23/1.70 in Case 3). The morphology of restenotic lesions was concentric in all cases.

　The high rSI on T₂WI and concentricity of the restenosis after CEA suggest early restenosis (intimal hyperplasia). The low-iso rSI on T₁WI and high rSI on T₂WI of the preoperative plaques are associated with restenosis after CEA. BB-MRI may be useful to evaluate and predict restenosis after CEA.

(Received: May 7, 2012, Accepted: September 10, 2012)