高分辨核磁共振对脑桥梗死不同病灶形态类型的病因机制研究  

Morphological classification of penetrating artery pontine infarcts and association with pathogenesis: high-resolution magnetic resonance imaging study

作　　者：杨曼纯 白小欣[2] 龙玉[3] 张燕婷[2] 蔡军[2] YANG Manchun;BAI Xiaoxin;LONG Yu(Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine,Guangzhou 510000,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510000 [2]广东省中医院脑病五科,广东广州510000 [3]广东省中医院影像科,广东广州510000

出　　处：《中风与神经疾病杂志》2019年第9期794-797,共4页Journal of Apoplexy and Nervous Diseases

基　　金：广东省教育厅重点平台科研项目(No.2017KTSCX039)

摘　　要：目的探讨急性孤立性脑桥梗死患者的梗死病灶形态与病因机制关系。方法回顾性纳入2016年3月~2019年2月广东省中医院收治的25例急性孤立性脑桥梗死患者,根据核磁共振弥散加权成像(DWI)梗死病灶形态类型分为脑桥旁中梗死(PPI)和脑桥深部小梗死(SDPI)。两组患者均在急性起病10 d内接受基底动脉的3.0T高分辨核磁共振成像(HR-MRI)检查,依据HRMRI基底动脉管壁与穿支动脉的特点区分不同的梗死病因机制,分为分支动脉粥样硬化病(BAD)和腔隙性梗死(LI)。比较两种分型方法是否存在差异性。结果DWI梗死灶形态分型显示,PPI组有15例(60.0%),SDPI组有10例(40.0%);HR-MRI的病因机制分型显示,BAD组有23例(92.0%),其中15例均表现为脑桥旁正中梗死,8例表现为脑桥深部小梗死,LI组有2例(8.0%);两种影像学分型比较,差异有统计学意义(P<0.05)。结论PPI与分支动脉粥样硬化所致的发病机制一致,SDPI需进一步接受高分辨核磁共振检查以明确梗死发病机制。Objective To investigate the morphological classification and pathogenesis in patients with isolated pontine infarction.Methods From March 2016 to February 2019,25 consecutive patients with isolated pontine infarction admitted to the Guangdong Province Hospital of TCM were enrolled retrospectively.According to the magnetic resonance diffusion-weighted imaging,it was divided into paramedian pontine infarction and small deep pontine infarction.Both groups underwent 3.0T high-resolution magnetic resonance imaging of the basilar artery within 10 days.Different etiological mechanisms were distinguished and divided into branch atheromatous disease and lacunar infarcts.The differences of classification methods were analyzed.Results The morphological classification of DWI showed that there were 15 of 25 patients(60.0%)in the PPI group and 10 of 25 patients(40.0%)in the SDPI group.The etiology of HR-MRI showed that there were 23 of 25 patients(92.0%)in the BAD group,15 with PPI and 8 with SDPI,and 2 of 25 patients(8.0%)in LI group.The difference between the two classification methods was statistically significant(P<0.05).Conclusion PPI are consistent with the pathogenesis of atherosclerosis.For patients with SDPI,HR-MRI is needed to determine the pathogenesis of infarction.

关 键 词：脑桥梗死 分支动脉粥样硬化病 腔隙性梗死 高分辨核磁共振成像 

分 类 号：R743[医药卫生—神经病学与精神病学]