高分辨率磁共振对大脑中动脉斑块与梗死灶类型关系的研究  

Study on the Relationship between Middle Cerebral Artery Plaque and Infarct Type by High-resolution Magnetic Resonance Imaging

作　　者：徐曼曼[1] 徐运[1] 周飞[1] 张鑫[1] 张冰[1] 王一峰 李敬伟[1,2] 

机构地区：[1]南京大学医学院附属鼓楼医院神经内科,南京210008 [2]南京鼓楼医院集团宿迁市人民医院神经内科

出　　处：《中国卒中杂志》2017年第12期1086-1092,共7页Chinese Journal of Stroke

基　　金：国家自然科学基金面上项目(81571134);青年科学基金项目(81200896);江苏省博士后科研资助计划(1501077A);江苏省六大人才高峰D类资助项目(2015-WSN-084);江苏省医学重点学科(实验室)(ZDXKA2016020)

摘　　要：目的本研究主要应用高分辨率磁共振成像(high-resolution magnetic resonance imaging,HRMRI)探索大脑中动脉(middle cerebral artery,MCA)粥样硬化所致狭窄与梗死灶分布类型的相关性,并进一步探索不同脑梗死类型与斑块性质、重塑率及患者发生卒中的可能机制。方法回顾性分析2012-2016年于南京鼓楼医院就诊的14 d内发生MCA供血区缺血性卒中并进行HRMRI扫描的患者临床资料。在弥散加权成像(diffusion weighted imaging,DWI)上将梗死类型分为穿支动脉梗死(perforating artery infarct,PAI)、皮质支供血区梗死(pial infarct,PI)、分水岭梗死(border zone infarct,BZI)和混合型梗死(PAI+PI,PAI+BZI,PI+BZI,PAI+PI+BZI)。在矢状位HRMRI上测量MCA M1段狭窄率及重构率,并收集斑块位置、长度、厚度等形态学指标。正性重构>1.05,负性重构<0.95。将PAI、PI、BZI的患者分入单型梗死组,将PAI+PI、PAI+BZI、PI+BZI、PAI+PI+BZI的患者归入混合型梗死组。结果共纳入51例MCA狭窄程度≤50%的患者,其中单型组32例,混合组19例。单型组中,PAI 22例(68.8%),PI 6例(18.7%),BZI 4例(12.5%),正性重构22例(68.8%)。混合组中PAI+BZI 7例(36.8%),PAI+PI 2例(10.6%),PI+BZI 5例(26.3%),PAI+PI+BZI 5例(26.3%),正性重构17例(89.5%)。混合型组的狭窄程度较单型组重(P=0.01),斑块厚度较单型组大(P=0.001),比较差异有统计学意义。结论不同程度的MCA狭窄,其梗死灶分布有所不同,单型梗死主要为PAI,混合型梗死主要以PAI+BZI多见。同时HRMRI发现对于轻型MCA狭窄的患者,血管的狭窄程度和斑块厚度增加可能与混合型梗死有关。Objective This study focused on the use of high-resolution magnetic resonance imaging（HRMRI） to analyze the relationship between the stenosis of the middle cerebral artery（MCA） atherosclerosis and the type of infarction distribution,and further explored the different types of cerebral infarction and plaque nature,remodeling rate and the possible mechanism of stroke in patients.Methods The clinical data of patients with MCA blood supplied ischemic stroke and highresolution magnetic resonance imaging within 14 days of treatment from Nanjing Drum Tower Hospital in 2012-2016 were analyzed retrospectively.Perforating artery infarct（PAI）,pial infarct（PI）,border zone infarct（BZI） and mixed infarcts（PAI＋PI,PAI＋BZI,PI＋BZI,PAI＋PI＋BZI） were performed on diffusion weighted imaging（DWI）.The stenosis rate and remodeling rate of MCA M1 were measured on sagittal HRMRI,and the morphological indexes such as position,length and thickness were collected.The reconstruction rate of positive remodeling（PR） was more than 1.05 and negative remodeling（NR） was low than 0.95.Patients with PAI,PI,and BZI were divided into single type infarct group.Patients with PAI＋PI,PAI＋BZI,PI＋BZ,PAI＋PI＋BZI were assigned to mixed type infarct group.Results A total of 51 patients with MCA stenosis ≤50% were included in the study.Among which,32 cases were in single type infarct group and 19 cases were in mixed type infarct group.There were 22 cases of patients with PAI（68.8%）,6 patients with PI（18.7%） and 4 with BZI（12.5%）,22 patients with PR（68.8%） in single.In the mixed type infarct group,7 were PAI＋BZI（36.8%）,2 were PAI＋PI（10.6%）,5 were PI＋BZI（26.3%） 5 were PAI＋PI＋BZI（26.3%）,and 17 were PR（89.5%）.The degree of stenosis in the mixed type infarct group was more severe（P=0.01） and the plaque thickness was larger（P =0.001） than single type infarct group,which had significant difference.Conclusion Different degrees of middle cerebral artery stenosis

关 键 词：高分辨率磁共振 大脑中动脉狭窄 脑梗死类型 斑块 

分 类 号：R743.3[医药卫生—神经病学与精神病学]