J-STAGE 症例報告 VISTA radiation-induced carotid stenosis 要旨 73 CEUS VISTA T1 RCS 82 TIA CEUS RCS 2 VISTA RCS MRI VISTA CEUS Key wo
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1 症例報告 VISTA radiation-induced carotid stenosis 要旨 73 CEUS VISTA T1 RCS 82 TIA CEUS RCS 2 VISTA RCS MRI VISTA CEUS Key words: radiation-induced carotid stenosis, VISTA, contrast enhanced ultrasonography はじめに Radiation-induced carotid stenosis RCS Gy 5 1, 2 RCS 10 3 RCS 2015 CEA carotid endarterectomy CAS carotid artery stenting 4 8 RCS carotid ultrasonography: CUS 9 11 contrast-enhanced doi: /jstroke ultrasound: CEUS Gujral RCS 12 vasavasorum RCS MRI T1 T1WI 16, 17 three-dimensional 3D volume isotropic turbo spin echo acquisition with that of 3D fast spin echo T1 VISTA T1 MRI Philips Medical Systems, Eindhoven, Netherlands 3 RCS CEUS VISTA T1 2 症例 /56 mmhg 96/ 20/ 36.6 C 1
2 Fig. 1 CUS A: Carotid duplex ultrasonogram (CUS) acquired in brightness mode (B-mode) reveal bilateral common arteries diffuse plaque with ulceration (arrow). B: Contrast-enhanced ultrasound (CEUS) shows bilateral common arteries diffuse plaque with ulceration. Contrast-enhanced plaque is seen (arrow). 5 Mingazzini BNP 12.2 pg/ml Precious 5 12 MHz CUS Fig. 1A Max peak systolic verbosity: Max PSV 119 cm/s 104 cm/s ED ratio CEUS Precious 5 12 MHz MI ml/kg 1 No CEUS Fig. 1B MRI DWI MRA RCS 75 mg 100 mg 2.5 mg mg 6 1 CUS Fig. 2 T1-VISTA Three-dimensional (3D) T1-weighted volume isotropic turbo spinecho acquisition (T1-VISTA, 3T, Ingenia, Philips; TR 400, TE 30) sagittal coronal MRI. A right internal artery high plaque is seen (arrow). 2 VISTA T1 plaque muscle ratio P/M 1.67 Fig CUS 1 1 VISTA 症例
3 脳 卒 中 J-STAGE 早期公開 2019 年 10 月 16 日 Fig. 3 CUS A: Color-coded duplex sonogram (CCDS) reveals a left bifurcation high-iso echoic plaque with ulceration. B: CEUS shows a left bifurcation enhanced plaque with ulceration. Contrast-enhanced plaque is seen (arrow). た 高血圧 脂質異常症 現病歴 農作業後歩行中 突然 右上肢の動きが悪く なり 10 分くらいで症状は消失したが 同日救急車で 来院した 入院時現症 血圧 140/80 mmhg 脈拍 85/分 整 体 温 36.7 C 頸部血管雑音なし 肺音 心音に特記所見は なかった 神経学的所見に異常所見はなかった 検査所見 血液検査に異常はなく 胸部レントゲンは 正常だった CUS では両側総頸動脈 右内頸動脈に石 灰化がある高輝度プラークを認めた 左総頸内頸動脈分 岐部に 表面不整で不均一な高輝度から等輝度プラーク Fig. 4 CUS B-mode and CCDS reveal a left bifurcation low echoic plaque with ulceration. による軽度狭窄で潰瘍を認めた Fig. 3A CEUS では左 内頸動脈軽度狭窄部プラークが造影された Fig. 3B 当 日の頭部 MRI DWI は陰性だったが 2 日後の頭部 MRI DWI では左前頭葉皮質中大脳動脈領域に高信号域を認 めた 頭蓋内 MRA では異常血管はなかった 造影 3DCTA では左内頸動脈起始部に 50 狭窄を認めた 同部 位を責任病巣と考え シロスタゾール内服を開始した その後 CUS はされていなかった 2 年後 トイレに 行ったときに右上肢の動かしにくさと呂律困難を自覚し て 救急車で来院した 頭部 MRI DWI では左頭頂葉皮 質に高信号域があり 頭蓋内 MRA では異常血管はな かった CUS では両側総頸動脈は高輝度プラークによ る軽度狭窄 右 area stenosis 42 左 area stenosis 43 であり 左内頸動脈は等輝度から低輝度 潰瘍を伴った プラークによる軽度狭窄 area stenosis 60 だった Fig. Fig. 5 T1-VISTA The T1-weighted volume isotropic turbo spin-echo (T1-VISTA, 3T, Ingenia, TR 400, TE 30) magnetic resonance imaging sagittal, coronal view shows a left internal artery high plaque (arrow). 4 脳血管造影で左内頸動脈狭窄部の潰瘍病変を確認し た VISTA で は P/M 比 1.41 の 高 輝 度 プ ラ ー ク だ っ た Fig. 5 抗血小板薬をアスピリン クロピドグレルの 併用療法に変更した その後 半年に 1 回 CUS 1 年に 3
4 1 VISTA follow-up 3 考察 VISTA Philips MRI 3D-T1-TSE time of flight-mr angiography TOF-MRA Black- Blood MRI 3 RCS transoral carotid ultrasonography: TOCU 18 TOCU TOCU VISTA RCS PubMed VISTA T1-TSE RCS RCS 1 mucopolysaccaride 2 vasa-vasorum focal necrosis 19, 20 CEUS vasa-vasorum CEUS RCS Gujral CUS 1 1 VISTA RCS CEA CAS 4, 5 CEUS VISTA RCS 1 CUS RCS RCS Black-Blood MRI 3D VISTA RCS 1 2 CEUS RCS 2 結 VISTA CEUS RCS 2 VISTA CEUS COI COI 語 参考文献 1 Xu J, Cao Y: Radiation-induced carotid artery stenosis: a comprehensive review of the literature. Interv Neurol 2: , small vessel disease 2 55: , Halak M, Fajer S, Ben-Meir H, et al: Neck irradiation: a risk factor for occlusive carotid artery disease. Eur J Vasc Endovasc Surg 23: , Fokkema M, den Hartog AG, Bots ML, et al: Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy: systematic review and meta-analysis. Stroke 43: , Tallarita T, Oderich GS, Lanzino G, et al: Outcomes of carotid artery stenting versus historical surgical controls for radiationinduced carotid stenosis. J Vasc Surg 53: e1 5, Huang MP, Fang HY, Chen CY, et al: Long-term outcomes of carotid artery stenting for radiation-associated stenosis. Biomed J 36: , CAS plaque protrusion 1 38: , CEA 44: , Dorresteijn LD, Kappelle AC, Scholz NM, et al: Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer 41: , : 67 73, Cheng SW, Ting AC, Wu LL: Ultrasonic analysis of plaque characteristics and intimal-medial thickness in radiation-induced atherosclerotic carotid arteries. Eur J Vasc Endovasc Surg 24: , Gujral DM, Shah BN, Bhattacharyya S, et al: Contrast-enhanced ultrasound to assess plaque neovascularization in irradiated carotid arteries. Int J Cardiol 202: 3 4, Gujral DM, Cheung WK, Shah BN, et al: Contrast enhancement of carotid adventitial vasa vasorum as a biomarker of radiationinduced atherosclerosis. Radiother Oncol 120: 63 68, Gujral DM, Shah BN, Chahal NS, et al: Clinical features of radiation-induced carotid atherosclerosis. Clin Oncol (R Coll Radiol) 26: , Shah BN, Gujral DM, Chahal NS, et al: Plaque neovascularization is increased in human carotid atherosclerosis related to pri- 4
5 or neck radiotherapy: A contrast-enhanced ultrasound study. JACC Cardiovasc Imaging 9: , Chung TS, Yousem DM, Lexa FJ, et al: MRI of carotid angiopathy after therapeutic radiation. J Comput Assist Tomogr 18: , Chan YL, Yeung DK, Leung SF, et al: Proton magnetic resonance spectroscopy of late delayed radiation induced injury of the brain. J Magn Reson Imaging 10: , TOCU 30: , Halle M, Gabrielsen A, Paulsson-Berne G, et al: Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries. J Am Coll Cardiol 55: , Zhao W, Robbins ME: Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: therapeutic implications. Curr Med Chem 16: , 2009 Abstract Two cases of symptomatic, radiation-induced carotid stenosis diagnosed and followed-up using contrast-enhanced ultrasonography and volume isotropic turbo spin-echo acquisition Junichi Uemura, M.D., 1) Naoki Oyama, M.D., 1) Toshiaki Goda, M.D., 1) Takanori Iwamoto, M.D., 1) and Yoshiki Yagita, M.D. 1) 1) Department of Stroke Medicine, Kawasaki Medical School We used contrast-enhanced ultrasonography (CEUS) and volume isotropic turbo spin-echo acquisition (VISTA) to diagnose two cases of symptomatic, radiation-induced carotid stenosis (RCS). Because the lesions were high-grade, carotid ultrasonography (CUS) were not effective. Case 1: A 73-year-old man was diagnosed with RCS-induced infraction by VISTA after 2 years. Clopidogrel and rosuvastatin were administered. Case 2: An 82-year-old man was diagnosed with RCS-induced transient ischemic attack using CUS, three-dimensional computed tomography and angiography; cilostazol was administered. Follow-up with CUS was not performed, and recurrence was observed 2 years after diagnosis. The lesion was confirmed using CUS and cerebral angiography, and clopidogrel and rosuvastatin were administered. Follow-up using CUS and VISTA were conducted, and no recurrence was observed after 2 years. Two cases were examined using CEUS and VISTA, these are concluded to be useful techniques for diagnose of patients with RCS. Key words: radiation-induced carotid stenosis, VISTA, contrast enhanced ultrasonography 5
脳 卒 中 J-STGE 早期公開 2015 年 11 月 13 日 Fig. 1 左総頸動脈撮影では起始部から狭窄を認めており 遠位端でも狭窄が強く NSCET 50 狭窄であった MRI plaque imaging sagittal view では T1WI で高信号であり soft plaq
J-STGE 2015 11 13 症 例 報 告 CS plaque protrusion 1 1 1 要 旨 CS 11 CS plaque protrusion 71 NSCET 50 NSCET 80 CS plaque protrusion soft plaque Key words: radiation-induced carotid artery stenosis, carotid artery
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