急性皮层下脑梗死的临床与弥散加权成像特点的比较研究  

Comparison of clinical and diffusion-weighted imaging features of acute subcortical white matter infarcts

作　　者：路雅宁[1] 宋静杰[1] 穆耀强[1] 

机构地区：[1]包头市第四医院神经内科,内蒙古包头014030

出　　处：《中风与神经疾病杂志》2013年第10期913-915,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的急性皮层下脑梗死(acute subcortical infarcts,ASCI)分为深穿支动脉脑梗死、浅穿支动脉脑梗死(superficial perforator infarcts,SPI)和内侧分水岭区脑梗死iInternal border-zone infarcts,IBI)。由于后二者不易鉴别,我们分析并比较SPI和IBI的临床特点及弥散加权成像(diffusion weighted imaging,DWI)特点,以明确两者的发病机制存在的差别。方法本研究利用已有的DWI模板,根据脑动脉支配区特点把ASCI患者分为SPI与IBI两组,分别比较这两组患者的基本信息、临床特点和影像学特点。结果 IBI组有39名患者,SPI组有62名患者。与IBI组患者相比,SPI组患者入院时美国国立卫生院神经功能缺损评分较低,患者可能存在心源性栓塞的比例较大,临床症状相对轻。IBI组患者的大脑中动脉的严重狭窄率或闭塞率更高,且其梗死灶常为串珠样(P<0.01)。而SPI组为更多伴随皮层小梗死病灶(P<0.01)。结论本研究结果证实IBI主要是脑动脉血流动力性障碍所致,而栓塞机制是SPI的重要发病机制。发病机制的差异导致两种不同亚型的脑梗死临床特点与神经影像学存在区别。Objective Subcortical infarcts can be divided into perforator infarcts, superficial perforator infarcts and internal border-zone infarcts. Because of difficulty in distinguishing between superficial perforator infarcts （SPI） and internal border-zone infarcts（IBI） , we made comparative analyses of clinieal and neuroradiological characteristics between SPI and IBI to clarify the difference in underlying pathogenesis with diffusion-weighted imaging （DWI）. Methods We select SPI and IBI on DWI using templates for the identification of subcortical vascular territories. Baseline patient clinical courses and neuroradiological features were compared between patients with IBI and SPI. Results We identified 39 IBI and 62 SPI pa- tients. The SPI group had lower National Institutes of Health Stroke Scale scores（ P = 0.01 ）, favorable clinical outcomes（ P =0. 028）,and more frequent potential sources of cardioembolism than the IBI group（P = 0. 031 ）. Cortical spotty lesions were more frequently accompanied by SPI than IBI（ P 〈 0.01 ）. IBI appeared in a chainlike fashion, and had a higher degree of stenosis or occlusion of middle eerebral artery eompared with SPI （ P 〈 0.01 ）. Conclusion IBI are caused mainly by he- modynamie compromise,whereas embolic pathogenesis appear to contribute greatly to the genesis of SPI. This finding may explain the difference in clinical and neuroradiologieal characteristics between the two groups.

关 键 词：浅穿支动脉脑梗死 分水岭区脑梗死 弥散加权成像 血流动力性障碍 栓塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]