Neurological Surgery 脳神経外科49巻2号

2021年03月発行

特集 脳神経画像Critical Findings—おさえておきたい症状とCT/MRI画像所見 Ⅶおさえておきたい特殊画像検査

Black-blood法によるplaque imaging

著者： 吉田和道¹

所属機関： ¹京都大学大学院医学研究科脳神経外科学

ページ範囲：P.432 - P.437

Point
・動脈硬化による虚血発症のリスク評価において，狭窄率のみでなく血管壁の性状が極めて重要である．
・血流信号を抑制するblack-blood MRIにより，プラーク性状を低侵襲かつ正確に評価できる．
・不安定プラークの特徴として，出血，脂質コア，菲薄化線維性被膜，陽性リモデリングなどが重要である．

参考文献

1）Naghavi M, et al：From vulnerable plaque to vulnerable patient：a call for new definitions and risk assessment strategies：Part I. Circulation 108：1664-1672, 2003

2）Brinjikji W, et al：Contemporary carotid imaging：from degree of stenosis to plaque vulnerability. J Neurosurg 124：27-42, 2016

3）吉田和道，他：Black blood MRIによる非侵襲的頚動脈プラーク性状評価．No Shinkei Geka 33：235-241, 2005

4）Yoshida K, et al：Evaluation of carotid artery atherosclerotic plaque distribution by using long-axis high-resolution black-blood magnetic resonance imaging. J Neurosurg 109：1042-1048, 2008

5）Gupta A, et al：Carotid plaque MRI and stroke risk：a systematic review and meta-analysis. Stroke 44：3071-3077, 2013

6）Chu B, et al：Hemorrhage in the atherosclerotic carotid plaque：a high-resolution MRI study. Stroke 35：1079-1084, 2004

7）Yoshida K, et al：Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging. AJNR Am J Neuroradiol 29：868-874, 2008

8）Saito A, et al：Carotid plaque signal differences among four kinds of T1-weighted magnetic resonance imaging techniques：a histopathological correlation study. Neuroradiology 54：1187-1194, 2012

9）Yuan C, et al：Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization. J Magn Reson Imaging 15：62-67, 2002

10）Trivedi RA, et al：MRI-derived measurements of fibrous-cap and lipid-core thickness：the potential for identifying vulnerable carotid plaques in vivo. Neuroradiology 46：738-743, 2004

11）Cai J, et al：In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque：comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation 112：3437-3444, 2005

12）Hatsukami TS, et al：Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation 102：959-964, 2000

13）Wasserman BA, et al：Carotid artery atherosclerosis：in vivo morphologic characterization with gadolinium-enhanced double-oblique MR imaging initial results. Radiology 223：566-573, 2002

14）Wasserman BA, et al：MRI measurements of carotid plaque in the atherosclerosis risk in communities（ARIC）study：methods, reliability and descriptive statistics. J Magn Reson Imaging 31：406-415, 2010

15）Gupta A, et al：Cost-effectiveness of carotid plaque MR imaging as a stroke risk stratification tool in asymptomatic carotid artery stenosis. Radiology 277：763-772, 2015

16）Lechtman E, et al：Cost-effectiveness of magnetic resonance carotid plaque imaging for primary stroke prevention in Canada. Br J Radiol 91：20170518, 2018

17）Glagov S, et al：Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316：1371-1375, 1987

18）Schoenhagen P, et al：Extent and direction of arterial remodeling in stable versus unstable coronary syndromes：an intravascular ultrasound study. Circulation 101：598-603, 2000

19）Kitagawa T, et al：Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging 2：153-160, 2009

20）Fukuda K, et al：Relationship between carotid artery remodeling and plaque vulnerability with T1-weighted magnetic resonance imaging. J Stroke Cerebrovasc Dis 23：1462-1470, 2014

21）Yoshida K, et al：The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation. J Neurosurg 123：434-440, 2015

22）Yamada K, et al：Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. Atherosclerosis 215：399-404, 2011

23）Yoshimura S, et al：High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 42：3132-3137, 2011

24）Maruyama D, et al：Evaluation of carotid artery outward remodeling by T1-weighted magnetic resonance imaging in carotid endarterectomy and stenting. J Vasc Surg 61：1464-1471. e1, 2015

25）Kashiwazaki D, et al：Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting. Acta Neurochir（Wien）159：1299-1304, 2017