皮层微梗死的临床危险因素及高场强磁共振成像研究  

Clinical risk factors and ultrahigh field magnetic resonance imaging features of cerebral microinfarcts

作　　者：付睿[1] 戴威[1] 岳云龙 李滨 陈立云[1] 席春江[1] 唐涛[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经内科,北京100038 [2]首都医科大学附属北京世纪坛医院核磁共振室,北京100038

出　　处：《中华神经医学杂志》2017年第9期876-880,共5页Chinese Journal of Neuromedicine

基　　金：中国铁路总公司科技研究开发计划课题（J2014C011-B）

摘　　要：目的分析急性缺血性脑卒中患者皮层微梗死（CMIs）的危险因素。评价3．0TMRI的双反转恢复fDIR）和三维液体衰减反转恢复（3D．FLAIR）序列对CMIs的诊断价值。方法选择北京世纪坛医院神经内科自2014年8月至2015年7月收治的发病7d内急性缺血性脑卒中患者110例。所有患者行MRI常规和DIR、3D—FLAIR序列扫描。根据MRJ结果将患者分为CMls组和无CMIs组，比较2组患者的临床资料，采用多元Logistic回归分析发生CMIs的独立危险因素。比较常规和DIR、3D—FLAIR序列扫描对CMIs的检出率。结果110例患者分为CMIs组（26例）和无CMIs组（84例）。CMIs组患者的平均年龄、〉65岁患者的比例、76～80岁患者的比例、高血压病、有缺血性脑卒中史、颅内动脉粥样硬化者比例明显高于无CMIs组患者，差异有统计学意义（P〈0．05）；多元Logistic回归分析显示：年龄（〉65岁）（OR=1．982，95％CI：1．362～2．889，P=-0．010）和高血压（OR=1．326．95％CI：1．022～1．682，P=0．026）是急性缺血性脑卒中患者发生CMIs的独立危险因素；与常规MRI序YU（10．9％）比较，DIR序列、3D-FLAIR序列对CMIs的检出率（23．6％、20．9％）均增高，差异均有统计学意义（P〈0．05）。结论高龄、高血压是急性缺血性脑卒中患者CMIs发生的独立危险因素。MRI特殊序列对CMIs的检出率优于常规序列。Objective To analyze the risk factors of cortical micro-infarcts （CMIs） in patients with acute ischemic stroke and to evaluate the diagnostic value of 3.0 Tesla （T） magnetic resonance imaging （MRI） using double inversion recovery （DIR） sequence and 3-dimensional fluid attenuated inversion recovery （3D-FLAIR） sequence in CMIs in vivo. Methods One hundred and ten consecutive patients with acute ischemic stroke within 7 d of onset were chosen from August 2014 to July 2015; these patients were classified into CMIs group and non-CMIs group by results of 3.0 conventional T MRI, D1R-MRI and 3D-FLAIR-MRI. Baseline characteristics and risk factors were analyzed to investigate the independent risk factors of CMIs. The presence of CMIs was evaluated based on conventional T MRI, DIR-MRI and 3D-FLAIR-MRI. Results Of the 110 enrolled patients with acute ischemic stroke, CMIs were presented in 23.6% patients （26/110）. The age of patients from the CMIs group was significantly older as compared with that of patients from the non-CMIs group （67.65±10.37 vs. 58.52± 11.24 years old, P=-0.009）. Patients from the CMIs group had significantly higher percentages of age〉65 years, age of 76-80 years, hypertension, history of cerebral ischemia and intracranial atherosclerosis than patients from non-CMIs group （P〈0.05）. Multivariate Logistic regression analysis indicated that age〉65 years （OR=1.982; 95%CI： 1.362-2.889, P=0.010） and hypertension （OR=1.326; 95%CI： 1.022-1.682, P=0.026） were the independent risk factors of CMIs. The prevalence of CMIs detected by conventional sequence （10.9%） was significantly lower than that detected by DIR sequence （23.6%） or 3D-FLAIR sequence （20.9%, P=0.013 and P=0.043）. Conclusions Age〉65 years and hypertension are independent risk factors ofCMIs. DIR and 3D-FLAIR sequences at 3.0 T MRI substantially improve the sensitivity of detection of CMIs as compared with conventional MRI sequence.

关 键 词：皮层微梗死 双反转恢复序列 三维液体衰减反转恢复序列 缺血性脑卒中 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]