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根据3.0T高分辩磁共振对颅内动脉粥样硬化狭隘血管壁改动与脑梗死联系的剖析

尤群伟+王志敏+顶峰[摘要]意图运用高分辩磁共振成像(HRMRI)对有症状性中动脉脑梗死和脑桥旁正中梗死患者的血管壁改动形式、剖析斑块的负荷与脑梗死的联系。办法搜集2014年1月~2016年1月间在本院神经内科住院的患者,大脑中动脉梗死23例和脑桥旁正中梗死21例,行3.0T高分辩磁共振及DWI和MRA查看,证明存在大脑中动脉梗死

尤群伟+王志敏+顶峰

[摘要] 意图 运用高分辩磁共振成像(HRMRI)对有症状性中动脉脑梗死和脑桥旁正中梗死患者的血管壁改动形式、剖析斑块的负荷与脑梗死的联系。 办法 搜集2014年1月~2016年1月间在本院神经内科住院的患者,大脑中动脉梗死23例和脑桥旁正中梗死21例,行3.0T高分辩磁共振及DWI和MRA查看,证明存在大脑中动脉梗死或脑桥旁正中梗死,别离丈量大脑中动脉和基底动脉管壁并核算最窄处血管面积/参阅处血管面积的指数,假如指数<0.95为阴性改动,指数在0.95~1.05之间为无改动,指数>1.05为阳性改动,比较阴性和陽性改动的斑块面积及斑块负荷等特色。 成果 对HRMRI上发现有动脉粥样硬化斑块的44例患者核算血管壁改动形式,在大脑中动脉发现阴性改动7例,无改动6例,阳性改动10例,而在基底动脉阴性改动3例,无改动4例,阳性改动14例。别离比较大脑中动脉阳性组的斑块面积(6.20±3.20)mm2(负荷核算公式=最窄层面斑块面积/最窄层面血管面积)及斑块负荷(0.42±0.14)mm2均大于阴性改动的斑块面积(2.10±1.40)mm2及斑块负荷(0.26±0.17)mm2;阳性组的斑块面积及斑块负荷均大于阴性组,两组比较差异有显著性(P<0.01)。 定论 HRMRI有助于颅内缺血性梗死的病因学分型并点评病变的指数,大脑中动脉和基底动脉的阳性改动比阴性改动常见,阳性改动常兼并较大的动脉粥样硬化斑块,且斑块面积及斑块负荷均大于阴性。

[关键词] 脑桥旁正中梗死;中动脉区梗死;动脉粥样硬化;HRMRI;基底动脉;斑块负荷

[中图分类号] R445.2;R743.3 [文献标识码] A [文章编号] 1673-9701(2017)22-0027-04

[Abstract] Objective To study the relationship between plaque burden and cerebral infarction by applying high resolution magnetic resonance imaging (HRMRI) to diagnose the changes of vascular wall in patients with symptomatic middle cerebral artery infarction and paramedian pons infarction. Methods A total of 23 patients with middle cerebral artery infarction and 21 patients with paramedian pons infarction in the department of neurology from January 2014 to January 2016 were collected and confirmed with the presence of middle cerebral artery infarction or paramedian pons infarction by 3.0T high resolution magnetic resonance and DWI and MRA examination.The vascular walls of the middle cerebral artery and basilar artery were measured and the index of blood area in the narrowest site/the vascular area of reference site was calculated. It was negative if the index<0.95, and no change happened if the index was in the range of 0.95~1.05, and it was positive change if the index>1.05. The features including plaque area and plaque burden between negative and positive changes were compared. Results The vessel wall alteration patterns of 44 patients with atherosclerotic plaques found on HRMRI were calculated. There were 7 cases of negative changes,6 cases of no change and 10 cases of positive changes found in the middle cerebral artery. There were 3 cases of negative changes,4 cases of no change and 14 cases of positive changes found in the basilar artery. The plaque area(6.20±3.20)mm2 (burden calculation formula=the narrowest plaque area/the narrowest vascular surface area) and the plaque burden(0.42±0.14)mm2 in the middle cerebral artery positive group were larger than the negative plaque area(2.10±1.40)mm2 and plaque load(0.26±0.17)mm2 in the middle cerebral artery negative group. The plaque area and the plaque burden in the basilar artery positive group were larger than those in the negative group. The differences were significant between the two groups(P<0.01). Conclusion HRMRI contributes to the etiology typing of intracranial ischemic infarction and assessment of the lesion index. The positive changes of the middle cerebral artery and basilar artery are more common than those with negative changes. The positive changes are often associated with large atherosclerotic plaques, and plaque area and plaque load of the positive changes were greater than those of negative changes.endprint

[Key words] Paramedian pons infarction; Middle artery area infarction; Atherosclerosis; HRMRI; Basilar artery; Plaque burden

颅内大动脉病变主要为大脑中动脉和基底动脉[1-2],大脑中动脉(MCA)狭隘的患者与椎基底动脉体系最常见脑桥旁正中梗死的患者别离每年发作卒中的风险高达12.5%和29.3%而且预后不良[3-4]。因而,對于研讨大脑中动脉及基底动脉管壁改动与脑梗死联系是有必要的,现在以为发作梗死的血管存在重构现象,临床常用的点评大脑中动脉和基底动脉的印象手法有颅多普勒、核算机断层血管造影(computed tomography angiography,CTA)、磁共振血管造影(magnetic resonance angiography,MRA)等这些血管成像技能只能显现动脉管腔,无法显现管壁结构,这会呈现尽管MCA、BA(基底动脉)等病变血管粥样硬化斑块现已开展但动脉管腔却未发作显着改动[5]。因而,运用HRMRI查看显现颅内动脉管壁结构,有利于明晰梗死的病因。

1目标与办法

1.1 研讨目标

为2014年1月~2016年1月期间在本院神经内科住院的患者44例。入组规范:①一切病例均经过颅脑磁共振成像(MRI)弥散加权成像(DWI)证明系急性大脑中动脉梗死或脑桥旁正中梗死。②一切患者扫除栓塞性梗死的可能;③一切患者均行MRA和HRMRI查看;均行血液炎性目标及血脂等风险要素查看,具有完好的病例材料。扫除规范:①具有MRI查看禁忌证患者;②病因为非动脉粥样硬化性患者。核算改动指数,阳性改动设为阳性组,阴性改动设为阴性组,两组根底材料差异无统计学含义(P>0.05),具有可比性。

1.2 办法

1.2.1 印象学查看 一切患者均行头颅CT查看扫除脑出血,并行头颅MRI查看,成像序列包含T1加权成像,T2加权成像,弥散加权成像,头颅MRA和HRMRI。本研讨选用3.0T磁共振机进行印象学查看。首先行MRA查看,然后取与MCA、BA长轴的笔直平面的HRMRI扫描查看。

1.2.2 点评丈量目标 图画由两位有经历的神经印象科医师在作业站上一起点评。如梗死灶、血管管腔和管壁等图画显现不明晰,则不归入本研讨。调查项目包含管壁、斑块、方位及巨细等,别离丈量大脑中动脉和基底动脉管壁并核算最窄处血管面积/参阅处血管面积的指数,比较阴性和阳性改动的斑块面积,斑块负荷等特色。

1.3统计学办法

选用SPSS 20.0统计学软件对各试验数据进行统计学剖析。组间比较选用t 查验,计数材料选用频数、百分比表明,两组间比较选用χ2查验或Fisher准确查验。P<0.05为差异有统计学含义。

2成果

2.1 印象学状况

在44例中MRA查看发现狭隘14例别离在中动脉8例、基底动脉6例,而HRMRI均发现有不同程度的偏疼斑块构成。T2WI上斑块信号改动表现为等信号,高信号为主,绝大多数斑块显现为不均质信号,假如结合T1发现高信号考虑斑块内出血,乃至结合增强斑块强化考虑活动性斑块。对HRMRI上发现有狭隘的44例患者,丈量最窄层面的面积,核算面积用USCUBE医学印象软件手动丈量(图1),参阅层面:取(病变近心端正常层面+远心端正常层面)/2的数值成果作为参阅层面,有助于下降人为要素挑选参阅面临指数的影响。

2.2 阴性组和阳性组的管壁特色

核算改动指数(最窄处血管面积比参阅处血管面积)(图2、3),<0.95为阴性,在0.95~1.05之间为无改动,>1.05为阳性改动。成果是阴性改动10例,无改动10例,阳性改动24例。在阴性组的指数为(0.81±0.12)和阳性组的指数为(1.29±0.21),差异具有显著性。成果阳性组在最窄层面的血管面积、斑块面积、斑块负荷均大于阴性组,差异具有显著性。在参阅层面,两组的管壁特色及最窄层面两组管腔面积,差异无统计学含义(P>0.05)。见表1。

3评论

本研讨显现HRMRI可明晰地显现大脑中动脉[6]及基底动脉管壁结构斑块状况[7-10]。而惯例的MRA查看有一些血管管腔未显着狭隘,但的确发作脑梗死,曾经病因归为原因不明或其他原因等,还有一部分患者呈现发展性卒中,曾经依据梗死的形状及散布估测病因或尸体解剖证明,活体内无法证明,但现有HRMRI后,可对这些活体患者查看,明晰病因,已在另一个研讨里证明斑块的散布与发展性卒中存在亲近的联系。对惯例查看管腔未显着狭隘的患者,经3.0T HRMRI查看发现这些患者的血管已有斑块构成,以为存在血管重构现象,发作向内或向外的重构,而且以为这种重构与脑梗死存在亲近的联系。因而有必要进行本研讨,成果如下:本研讨44例有症状患者均有颅内动脉的斑块构成,斑块在HRMRI表现为偏疼型斑块为多,而30例在MRA图画显现为正常管腔,HRMRI比MRA对颅内血管显现更清楚,而且能够显现管壁结构;一般惯例印象只显现管腔是不能满意临床需求的,而且对23例大脑中动脉和21例基底动脉粥样斑块患者核算血管改动指数(核算公式改动指数=最窄处血管面积/参阅处血管面积),假如指数<0.95为阴性改动,指数在0.95~1.05之间为无改动,指数>1.05为阳性改动,本研讨发现阳性改动共24例(中动脉阳性10例,基底动脉阳性14例),阴性改动共10例,无改动10例。脑梗死患者中阳性改动占54%,阴性改动和无改动约为23%,经统计剖析脑梗死和血管阳性改动有亲近的联系,剖析原因颅内动脉的这种血管结构改动,可能与血液在血管内活动的力学效果有关,以血管向外胀大性成长为主,所以以为高分辩率磁共振查看能发现血管结构的改动,另本研讨数据显现发现脑梗死患者以阳性改动为主,且阳性改动的血管斑块的负荷面积更大(负荷核算公式=最窄层面斑块面积/最窄层面血管面积),剖析原因与血管胀大性成长动脉粥样硬化斑块负荷面积大简单斑块掉落堵塞远端血管导致梗死的发作,在国内有文献报导:有动脉粥样硬化斑块的大脑中动脉狭隘进行微栓子监测,存在阳性的病变常可见栓子掉落,提示斑块不稳定[11-12]。还有报导运用HRMRI查看能明晰烟雾病和动脉粥样硬化的血管壁结构改动[13]。因而运用HRMRI能够明晰脑梗死的病因病理机制[14],也能发现易损斑块,猜测梗死的发作[15-18]或可能加剧发展,对临床有重要的辅导含义,另因为存在血管的阳性改动内行介入时能够引导支架植入避免“雪犁效应”,而堵塞穿支动脉[19-20]。endprint

综上可知,HRMRI能明晰显现颅内动脉血管壁的改动,经过该查看能明晰一些临床上表现为脑梗死但惯例血管查看未见显着血管狭隘患者的病因,补偿其他查看的缺乏,对辅导医治和防备是具有重要临床含义。缺乏之处是本研讨样本量少,取血管平面带有部分主观性,望在今后研讨中补偿这些缺乏,但本研讨的数据实在客观仍具有必定代表性。

[参阅文献]

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(收稿日期:2017-05-07)endprint

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尤群伟+王志敏+顶峰[摘要]意图运用高分辩磁共振成像(HRMRI)对有症状性中动脉脑梗死和脑桥旁正中梗死患者的血管壁改动形式、剖析斑块的负荷与脑梗死的联系。办法搜集2014年1月~2016年1月间在本院神经内科住院的患者,大脑中动脉梗死23例和脑桥旁正中梗死21例,行3.0T高分辩磁共振及DWI和MRA查看,证明存在大脑中动脉梗死