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Neurological Surgery No Shinkei Geka Volume 33, Issue 3 （March 2005）

Neurological Surgery 脳神経外科 33巻3号（2005年3月発行）

Japanese English

研究

Black blood MRIによる非侵襲的頸動脈プラーク性状評価 Noninvasive Carotid Plaque Characterization by Black Blood MRI 吉田和道 ¹ , 後藤正憲 ¹ , 舟木健史 ¹ , 押本剛 ¹ , 綿谷崇史 ¹ , 鳴海治 ¹ , 沈正樹 ¹ , 山形専 ¹ Kazumichi YOSHIDA ¹ , Masanori GOTO ¹ , Takeshi FUNAKI ¹ , Takeshi OSHIMOTO ¹ , Takafumi WATAYA ¹ , Osamu NARUMI ¹ , Masaki CHIN ¹ , Sen YAMAGATA ¹ ¹財団法人倉敷中央病院脳神経外科 ¹Department of Neurosurgery,Kurashiki Central Hospital キーワード： carotid stenosis , plaque characterization , black blood MRI Keyword: carotid stenosis , plaque characterization , black blood MRI pp.235-241

発行日 2005年3月1日 Published Date 2005/3/1

DOI https://doi.org/10.11477/mf.1436100042

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　頸動脈狭窄症の治療においては狭窄率のみでなくプラークの性状を評価することも非常に重要である．特にcarotid stenting（CAS）が急速に普及しつつある現状では^8,15,17)，その適応を判断するうえで正確かつ侵襲性の低いプラーク評価法の必要性がますます高くなっている．

　近年，機器の発達と撮像法の進歩に伴い，高分解能magnetic resonance image（MRI）を用いたプラーク評価が新たな試みとして注目されている^2,4,13,18)．そこでわれわれは非侵襲的プラーク評価におけるblack blood MRI（BB-MRI）⁷⁾の有用性を検討したのでここに紹介する．

Management of atherosclerotic carotid arteries requires both plaque characterization and determination of the degree of stenosis,especially when carotid stenting (CAS) is being considered for severe carotid stenosis. Recent studies have demonstrated that high-resolution MRI can identify plaque components,such as the lipid-rich necrotic core, intraplaque hemorrhage, fibrous tissue, and the calcification present in human carotid atherosclerosis. The purpose of this study was to assess the feasibility of black blood MRI (BB-MRI) for accurately identifying the plaque components in vivo.

　Twenty-six consecutive patients scheduled for carotid endarterectomy (CEA) underwent a BB-MRI examination within 2 weeks before the surgical procedure using a 1.5-T Philips scanner with a protocol that generated 2 contrast weightings (T1 and T2). The MR images were acquired using cardiac gating to minimize motion artifact and fat suppression to reduce MR signals from subcutaneous fatty tissue. The plaque evaluations obtained by BB-MRI were compared with the intra-operative video recordings, the excised specimens,and the histological sections.

　With BB-MRI, the combination of the signal intensities in the T1- and T2- weighted images for each component (lipid deposits, intra-plaque hemorrhage, fibrous plaque, and calcification) showed findings that corresponded with the excised specimens. Complex morphological features could also be assessed by BB-MRI.

　BB-MRI is a useful method for noninvasively imaging and characterizing atherosclerotic carotid arteries. This MRI technique can provide valuable information that can be used to decide whether to perform a CEA or a CAS in patients with severe carotid stenosis. Furthermore,BB-MRI appears to be a useful tool for the investigation of the pathogenesis and natural history of carotid atherosclerosis.