症状性大脑中动脉M1段重度狭窄/闭塞患者磁共振血流信号与短期预后的关系  

Correlation between Blood Flow Signal of Magnetic Resonance Imaging and Short-term Outcome in Patients with Symptomatic Severe Stenosis or Occlusion of Middle Cerebral Artery Ml segment

作　　者：束礼明 陈红兵[1] 尚文锦[1] 梁嘉辉 肖素 黄欣怡[1] 洪华[1] SHU Li-ming;CHEN Hong-bing;SHANG Wen-jin;LIANG Jia-hui;XIAO Su;HUANG Xin-yi;HONG Hua(Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院神经内科,广东广州510080

出　　处：《中山大学学报（医学版）》2018年第3期377-385,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技产学研协同创新重大专项(2014Y2-00502);广东省医学科学技术研究基金(A2017219);广东省重大神经疾病诊治研究重点实验室(2014B030301035);华南神经疾病早期干预及功能修复研究国际合作基地(2015B050501003);广州市重大神经系统疾病临床医学研究与转化中心(201604020010);广东省神经系统疾病重大疾病诊治工程技术研究中心(2016A030310165)

摘　　要：【目的】探讨症状性大脑中动脉(MCA)M1段重度狭窄和闭塞患者三维时间飞跃法磁共振血管成像(3D-TOF-MRA)上血流信号与短期预后的关系。【方法】回顾性连续纳入2009年5月至2016年5月入院的症状性MCA-M1段重度狭窄和闭塞患者。收集患者的一般信息、临床资料和头颅影像学数据。分析患者在3D-TOFMRA上血流信号特点,包括:(1)MCA病变远端血流信号;(2)大脑后动脉(PCA)偏侧化。分析MCA-M1段重度狭窄和闭塞患者3D-TOF-MRA上血流信号特点与短期预后的关系。【结果】共纳入328例患者,MCA-M1段重度狭窄患者154例,闭塞患者174例。对于MCA-M1段重度狭窄患者,MCA远端血流信号差与短期预后不良独立相关[优势比(OR)0.32,95%置信区间(95%CI)0.14~0.72],但PCA偏侧化与短期预后无统计学相关性(OR 2.28,95%CI 0.85~6.15);对于MCA-M1段闭塞患者,出现PCA偏侧化与短期预后良好独立相关(OR 3.54,95%CI 1.32~9.48),但MCA远端血流信号与短期预后无统计学相关性(OR 0.58,95%CI 0.22~1.48)。【结论】症状性MCA重度狭窄和闭塞患者的短期预后与3D-TOF-MRA的血流信号有关,但两者的特点不同。MCA-M1段重度狭窄患者的短期预后与3D-TOF-MRA上显示的MCA-M1段病变远端血流信号(前向血流信号)相关;MCA-M1段闭塞患者的短期预后与3D-TOF-MRA上的PCA偏侧化(侧支循环血流信号)相关。【Objective】To investigatethe correlation between blood flow signal on three dimensional time-of-flight magnetic resonance angiography（3 D-TOF-MRA）and short-term outcome in patients with symptomatic middle cerebral artery（MCA）severe stenosis or MCA occlusion.【Methods】We retrospectively reviewed consecutive patients with symptomatic MCA severe stenosis or MCA occlusion. General information,clinical data and cranial imaging data were collected. Characteristics of blood flow signal on 3 D-TOF-MRA for each patient were analyzed,which included：（1）blood flow signal of MCA distal to stenosis/occlusion lesion;（2）laterality of posterior cerebral artery（PCA）. The correlation between characteristics of blood flow signal and short-term outcome was analyzed.【Results】Three hundred and twenty-eight patients were included in this study. There were 154 patients with symptomatic MCA severe stenosis and the rest of them had symptomatic MCA occlusion. Poor blood flow signal of distal MCA independently correlated with poor short-term outcome in patients with severe MCA stenosis.[Odds Ratio（OR）0.32,95% Confident Interval（CI）0.14-0.72]. PCA laterality was not related with short-term outcome in these patients（OR,2.28,95% CI,0.85-6.15）. PCA laterality independently correlated with poor short-term outcome in patients with MCA occlusion.（OR,3.54,95% CI,1.32-9.78）.Blood flow signal of distal MCA was not related with short-term outcome in these patients（OR,0.58,95% CI,0.22-1.48）.【Conclusion】Blood flow signal on 3 D-TOF-MRA correlates with short-term outcome in patients with symptomatic MCA severe stenosis or occlusion but the characteristics differs between severe MCA stenosis and occlusion patients. Anterograde blood flow（blood flow signal of MCA distal to stenosis lesion）for patients with severe MCA stenosis and retrograde blood flow（PCA laterality）for patients with MCA occlusion correlates with shot-term outcome.

关 键 词：脑梗死 大脑中动脉 重度狭窄 闭塞 磁共振血管成像 大脑后动脉偏侧化 短期预后 

分 类 号：R743.32[医药卫生—神经病学与精神病学]