Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography associated with the risk of acute ischemic stroke occurrence,European Radiology

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Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography associated with the risk of acute ischemic stroke occurrence
European Radiology ( IF 4.7 ) Pub Date : 2023-11-25 , DOI: 10.1007/s00330-023-10404-w
Jingping Wu _{1,

2} , Ying Zou ₂ , Xiao Meng ₃ , Zhaoyang Fan ₄ , Rob van der Geest ₅ , Fang Cui ₆ , Jianyong Li ₆ , Tengyuan Zhang ₆ , Fan Zhang _{1,

2}

Affiliation

Objectives

Carotid atherosclerosis plays an essential role in the occurrence of ischemic stroke. This study aimed to investigate whether a larger burden of napkin-ring sign (NRS) plaques on cervicocerebral computed tomography angiography (CTA) increased the risk of acute ischemic stroke (AIS).

Methods

This retrospective, single-center, cross-sectional study enrolled patients with NRS plaques identified in the subclavian arteries, brachiocephalic trunk, carotid arterial system, and vertebrobasilar circulation on contrast-enhanced cervicocerebral CTA. Patients were divided into AIS and non-AIS groups based on imaging within 12 h of symptom onset. Univariate and multivariate logistic regression analyses were performed to determine the risk factor of AIS occurrence.

Results

A total of 202 patients (66.72 years ± 8.97, 157 men) were evaluated. Plaques with NRS in each subject of the AIS group (N = 98) were significantly more prevalent than that in the control group (N = 104) (1.96 ± 1.17 vs 1.41 ± 0.62). In the AIS group, there were substantially more NRS plaques on the ipsilateral side than contralateral side (1.55 ± 0.90 vs. 0.41 ± 0.66). NRS located on the ipsilateral side of the AIS showed an area under the receiver curve (AUC) of 0.86 to identify ischemic stroke. NRS plaque amounts were an independent risk factor for AIS occurrence (odds ratio, 1.86) after adjusting for other factors.

Conclusions

Increased incidence of napkin-ring sign plaques on cervicocerebral CTA was positively associated with AIS occurrence, which could aid in detecting asymptomatic atherosclerotic patients at high risk of AIS in routine screening or emergency settings.

Clinical relevance statement

Napkin-ring sign plaque provides an important imaging target for estimating acute ischemic stroke risk and identifying high-risk patients in routine screening or emergency settings, so that timely anti-atherosclerotic therapy can be used for prevention.

Key Points

• This cross-sectional study investigated the association between high-risk carotid artery plaques and acute ischemic stroke.

• Increased incidence of napkin-ring sign plaques on cervicocerebral computed tomography angiography is positively associated with acute ischemic stroke occurrence.

• Napkin-ring signs help identify risky patients prone to acute ischemic stroke to facilitate prevention.

中文翻译：

颈脑计算机断层扫描血管造影中餐巾环标志斑块的发生率增加与急性缺血性中风发生风险相关

目标

颈动脉粥样硬化在缺血性脑卒中的发生中起着至关重要的作用。本研究旨在调查颈脑计算机断层扫描血管造影（CTA）上较大的餐巾环征（NRS）斑块负担是否会增加急性缺血性中风（AIS）的风险。

方法

这项回顾性、单中心、横断面研究纳入了通过对比增强颈脑 CTA 在锁骨下动脉、头臂干、颈动脉系统和椎基底动脉循环中发现 NRS 斑块的患者。根据症状出现 12 小时内的影像学检查，将患者分为 AIS 组和非 AIS 组。进行单变量和多变量逻辑回归分析以确定 AIS 发生的危险因素。

结果

共有 202 名患者（66.72 岁 ± 8.97 岁，157 名男性）接受了评估。 AIS 组每位受试者 ( N = 98) 的 NRS 斑块明显多于对照组 ( N = 104) (1.96 ± 1.17 vs 1.41 ± 0.62)。在 AIS 组中，同侧的 NRS 斑块明显多于对侧（1.55 ± 0.90 vs. 0.41 ± 0.66）。位于 AIS 同侧的 NRS 显示接收器曲线下面积 (AUC) 为 0.86，可识别缺血性中风。调整其他因素后，NRS 斑块数量是 AIS 发生的独立危险因素（优势比为 1.86）。