高分辨率磁共振检测颅内动脉斑块预测缺血性脑血管事件的研究  

Detecting intracranial atherosclerotic plaques with high-resolution MR angiography for predicting ischemic cerebrovascular disease

作　　者：吕晋浩 马宁[4] 袁景林[2] 詹炯[5] 缪中荣[4] 娄昕[3] 

机构地区：[1]解放军总医院放射科,北京100853 [2]山西省晋煤集团总医院放射科 [3]首都医科大学大兴医院神经内科 [4]首都医科大学附属北京天坛医院脑血管病中心急诊介入科 [5]首都医科大学附属北京天坛医院放射科

出　　处：《中华神经外科杂志》2015年第5期444-447,共4页Chinese Journal of Neurosurgery

基　　金：首都医科大学基础临床科研合作课题（13JL40）;北京市优秀人才培养项目（201313003034000014）;国家自然科学基金（81101034）

摘　　要：目的 探讨应用高分辨磁共振血管成像（HRMRA）检测颅内动脉粥样硬化性斑块强化预测缺血性脑血管事件.方法 前瞻性纳入2008年5月至2012年10月在解放军总医院及首都医科大学附属北京天坛医院连续住院的症状性颅内动脉粥样硬化性中、重度狭窄患者.入组后均行HRMRA检查,评估责任血管斑块的强化特点.观察规律的内科治疗后1年间脑血管缺血性事件的发生情况.结果 纳入42例,其中基底动脉狭窄20例（47.6％）,大脑中动脉狭窄22例（52.4％）;脑梗死23例（54.8％）,短暂性脑缺血发作（TIA） 19例（45.2％）.1年间发生TIA和脑梗死各4例（事件组）,无事件组34例.两组患者年龄、性别、动脉粥样硬化的危险因素、病变血管及末次发病事件差异均无统计学意义（P＞0.05）;事件组和无事件组的末次发病至接受检查时间分别为（39.1±16.4）、（25.0±15.6）d,P=0.000.HRMRA显示两组责任血管有斑块强化者36例,其中事件组7例（7/8）,无事件组29例（29/34）,两组强化发生率差异无统计学意义（OR值=1.00,95％ CI：0.07～13.87,P=1.00）.事件组中,中度强化者5例,重度强化2例;非事件组中,中度强化19例,重度强化10例,两组强化程度比较,差异无统计学意义（OR值=1.32,95％CI：0.22～8.04,P=0.77）.结论 颅内动脉粥样硬化性中、重度狭窄患者斑块强化特点可能不是影响患者1年期脑血管事件的因素.Objective To investigate the Contrast enhancement of intracranial atherosclerotic plaque for prediction of ischemic cerebrovascular events with high-resolution MR angiography （HRMRA）.Methods The moderate to severe stenosis patients with symptomatic intracranial atherosclerosis admitted to Chinese PLA General Hospital and Beijing Tiantan Hospital,Capital Medical University from May 2008 to October 2012 were enrolled prospectively.All patients performed HRMRA after grouping,and the enhanced features of guilty vascular plaques were assessed.The occurrence of ischemic cerebrovascular disease was observed after one year regular medical treatment.Results Forty-two patients were enrolled in the study,including 20 （47.6%） basilar artery stenoses and 22 （52.4%） middle cerebral artery stenoses,23 （54.8%） cerebral infarction,and 19 （45.2%） transient ischemic attack （TIA）.Four patients had TIA and 4 had cerebral infarction （event group） in one year.There were 34 patients in a non-event group.There were no significant differences in age,gender,risk factors for atherosclerosis,lesion vessels,and last event between the two groups （P 〉0.05）.The time from the last symptom onset to HRMRA was 39.1 ± 16.4 d and 25.0 ± 15.6 d for the event group and the non-event group respectively （P =0.000）.HRMRA revealed that 36 patients had plaque enhancement in guilty vessels in both groups,including 7 （87.5%） in the event group and 29 （85.3%） in the non-event group.There was no significant difference in the incidence of plaque enhancement between the two groups （OR,1.00,95% CI 0.07-13.87,P =1.00）.Five patients had moderate enhancement and 2 had severe enhancement in the event group;19 had moderate enhancement and 10 had severe enhancement in the non-event group.There was no significant difference in the comparison of enhancement degree between the two groups （OR,1.32,95 CI 0.22-8.04,P =0.77）.Conclusion The plaque enhancement features in patients with moderate to severe intracranial atheros

关 键 词：卒中 脑缺血 斑块 动脉粥样硬化 磁共振血管造影术 高分辨 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]