目的：采用高分辨血管壁成像(high-resolution vessel wall imaging, HR-VWI)探讨大脑中动脉(middle cerebral artery, MCA)斑块特征与缺血性卒中复发的相关性。方法：回顾性分析105例经血管壁成像确认大脑中动脉存在斑块的患者资料，根据有无狭窄血管同侧急性缺血性卒中事件及其发生次数分为初发组（组1，n=61）、复发组（组2，n=19）、非症状组（组3，n=25）。采用方差分析、卡方检验、Fisher精确概率法或曼-惠特尼U检验对比分析三组患者大脑中动脉狭窄率、重构指数及斑块特征（强化比率、强化等级、斑块负荷、T1高信号、斑块位置）。将与复发可能相关的危险因素进行Logistic回归分析。结果：复发组及初发组与非症状组比较，均具有更大的斑块负荷、强化比率及更多的正性重构（P均<0.05）。复发组与初发组比较，有更大的斑块负荷（P=0.005）、管腔狭窄率（P=0.006）及更多的环周斑块（P=0.008）。多因素分析示斑块负荷是与复发相关的唯一独立危险因素（OR=1.075, 95% CI 1.019-1.133, P=0.008）。结论：斑块负荷是与大脑中动脉缺血性卒中复发相关的独立危险因素，可作为预警缺血性卒中复发的有效影像学标志物。
Objective: To investigate the relationship between middle cerebral artery(MCA) plaque features on high-resolution vessel wall imaging(HR-VWI) and acute ischemic stroke/TIA recurrence. Methods: We retrospectively analyzed the HR-VWI and clinical data of 105 patients with atherosclerotic plaques on MCA. They were divided into group 1, with the first episode of acute ischemic stroke/TIA (n=61); group 2, with recurrent acute ischemic stroke/TIA (n=19); group 3, with no occurrence of clinical event(n=25). The degree of stenosis, remodeling index and plaque features (enhancement ratio, enhancement grade, plaque burden, T1 signal intensity, and plaque distribution) were measured and compared among groups using analysis of variance, chi-square, Fisher's exact test or Mann-Whitney U test. Regression models investigated risk factors for recurrent stroke/TIA. Results: Plaque burden, enhancement ratio, remodeling index were all significantly higher in group 1 and 2, compared to group 3 (all P < 0.05). Higher plaque burden (P=0.005), higher stenosis degree (P=0.006) and more concentric plaque (P=0.008) were found in group 2 compared to group 1 (P<0.05). Multivariable logistic regression shows plaque burden was the only significant plaque marker associated with recurrent stroke/TIA (OR=1.075, 95% CI 1.019-1.133, P=0.008). Conclusion: Higher plaque burden of MCA was independently associated with recurrent acute ischemic stroke/TIA and can be an effective imaging marker for alarming the ischemic stroke recurrence.