缺血性卒中或短暂性脑缺血发作患者FLAIR序列高信号血管征可能与脑侧支循环有关：回顾性病例系列研究  

Hyperintense vessel sign on FLAIR maybe associated with cerebral collateral circulation in patients with acute ischemic stroke or transient ischemic attack： a retrospective case series study

作　　者：黄显军[1,2] 周志明[1] 刘文华[2] 朱武生[2] 徐格林[2] 刘新峰[2] 

机构地区：[1]皖南医学院弋矶山医院神经内科,芜湖241001 [2]南京大学医学院临床学院、南京军区南京总医院神经内科,210002

出　　处：《国际脑血管病杂志》2014年第3期161-166,共6页International Journal of Cerebrovascular Diseases

基　　金：安徽省高校自然科学研究项目（KJ20138313）,国家自然科学基金（81171110）

摘　　要：目的探讨缺血性卒中或短暂性脑缺血发作（transient ischemic attack，TIA）患者液体衰减反转恢复序列（fluid—attenuated inverson recovery，FLAIR）高信号血管征（hyperintense vessel sign，HVS）的可能形成机制和影像学特征。方法回顾性从南京卒中注册系统中提取自2010年1月到2011年7月期间临床表现为大脑中动脉（middle cerebral artery，MCA）供血区缺血性卒中或TIA且数字减影血管造影（digital subtraction angiography，DSA）显示MCAM1段病变患者的基线资料，FLAIR观察HVS，DSA评估血管狭窄程度和脑侧支循环。结果共纳入101例患者，男性76例（75．2％），平均年龄（53．94±13．47）岁；缺血性卒中90例（89．1％），TIA11例（10．9％）；HVS阴性55例（54．5％），HVS阳性46例（45．5％）。在MCA狭窄程度〈50％、50％～70％、70％～90％以及≥90％的患者中，HVS阳性率依次为0％（0／8）、25．0％（3／12）、17．6％（3／17）和62．5％（40／64），差异有显著统计学意义（Z=-4．479，P〈0．001）。HVS阳性组软脑膜侧支循环显著性多于HVS阴性组（Z=-6．196，P〈0．001）。多变量logistic回归分析显示，MCA狭窄程度是影响HVS形成的独立危险因素（优势比3．943，95％可信区间2．03～7．659；P〈0．001）。结论颅内大血管严重狭窄或闭塞后形成的颅内软脑膜侧支循环是缺血性卒中或TIA患者FLAIR序列HVS形成的主要病理生理学基础。Objective To investigate the possible formation mechanism and imaging features of the hyperintense vessel sign （HVS） on fluid attenuated inversion recovery （FLAIR） in patients with ischemic stroke or transient ischemic attack （TIA）. Methods The baseline data of the patients with middle cerebral artery （MCA） ischemic stroke or TIA with digital subtraction angiography （DSA） showing the lesions of MCA M1 segment in clinical practice were retrospectively retrieved from Nanjing Stroke Registry Program from January 2010 to July 2011. FLAIR was used to observe HVS, and DSA was used to evaluate the degree of vascular stenosis and cerebral collateral circulation. Results A total of 101 patients were enrolled, 76 （75.2%） were males, and their mean age was 53.94 ±13.47 years; 90 patients （89. 1%） with ischemic stroke and 11 patients （10. 9%） with TIA; 55 patients （54. 5%） were HVS negative and 46 （45.5%） were HVS positive. Among the patients whose MCA stenosis 〈50%, 50% -70%, 70% -90% and ≥90%, the positive rates were 0% （0/8）, 25.0% （3/12）, 17. 6% （3/17）, and 62.5% （40/64）, respectively. There were significant differences （Z= -4.479, P〈 0.001）. The leptomeningeal collateral circulation of the HVS positive group was significantly more than that of the HVS negative group （Z = - 6. 196, P 〈 0. 001 ）. Multivariate logistic regression analysis showed that the degree of MCA stenosis was an independent risk factor for influencing the formation of HVS （odds ratio 3. 943, 95% confidence interval 2. 03-7. 659; P 〈 0. 001）. Conclusions The formed intracranial leptomeningeal collateral circulation after severe intracranial vascular stenosis or occlusion is a major pathophysiological basis of HVS formation on FLAIR sequences in oatients with ischemic stroke or TIA.

关 键 词：卒中 脑缺血 梗死 大脑中动脉 侧支循环 磁共振成像 脑血管造影术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]