大脑中动脉粥样硬化性狭窄患者高分辨率磁共振成像血管壁特征与缺血性卒中风险  

High-resolution magnetic resonance imaging vascular wall characteristics and risk of ischemic stroke in patients with middle cerebral artery atherosclerotic stenosis

作　　者：顾军[1] 王觅 张丹凤[1] 张卫东[1] Gu Jun;Wang Mi;Zhang Danfeng;Zhang Weidong(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院医学影像科,210006

出　　处：《国际脑血管病杂志》2021年第6期401-406,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的:探讨大脑中动脉(middle cerebral artery, MCA)粥样硬化性狭窄患者高分辨率磁共振成像血管壁特征与缺血性卒中的相关性。方法:前瞻性纳入2016年1月至2020年1月在南京医科大学附属南京医院神经内科收治的缺血性脑血管病患者。患者临床表现为短暂性脑缺血发作或缺血性卒中,磁共振血管造影显示同侧MCA狭窄程度为50%~99%,且确定为责任病变。进行常规MRI及MCA最狭窄处血管壁成像。比较急性缺血性卒中组和非急性缺血性卒中组MCA狭窄处的血管和斑块特征。应用多变量 logistic回归分析确定急性缺血性卒中的独立危险因素。应用受试者工作特征(receiver operating characteristic, ROC)曲线确定血管壁特征对急性卒中的预测价值。 结果:共纳入65例存在MCA狭窄的缺血性脑血管病患者。患者年龄(68±14)岁,男性50例(76.9%)。急性缺血性卒中组30例(46.2%),非急性缺血性卒中组35例(53.8%),两组人口统计学资料、血管危险因素以及常规实验室检查均差异无统计学意义。与非急性缺血性卒中组比较,急性缺血性卒中组最狭窄处管腔面积较小[(2.36±1.09)mm 2对(2.96±1.01)mm 2;t=2.274, P=0.027],斑块面积[(4.46±2.08)mm 2对(2.62±1.32)mm 2;t=4.315, P<0.001]较大,重构指数(1.08±0.11对0.94±0.10;t=5.573, P<0.001)较高,而且明显强化斑块(63.3%对11.4%;χ2=19.034, P<0.001)和正性重构(80.0%对20.0%;χ2=23.311, P<0.001)更多。多变量 logistic回归分析显示,斑块面积(优势比2.01,95%置信区间1.35~2.98;P=0.001)、重构模式(优势比16.00,95%置信区间4.73~54.15;P<0.001)、最狭窄处管腔面积(优势比0.568,95%置信区间0.34~0.96;P=0.033)和强化程度(优势比21.85,95%置信区间5.13~93.00;P<0.001)是急性缺血性卒中的独立危险因素。ROC曲线分析显示,斑块面积、最狭窄处管腔面积和强化程度三者结合的预测效能最佳(曲线下面积0.93,95%置信区间0.84~0.96)。 结论:当MCA最狭窄处斑块�Objective To investigate the correlation between the high-resolution magnetic resonance imaging(MRI)vessel wall characteristics and risk of ischemic stroke in patients with middle cerebral artery(MCA)atherosclerotic stenosis.Methods Patients with ischemic cerebrovascular disease treated in the Department of Neurology,Nanjing First Hospital,Nanjing Medical University from January 2016 to January 2020 were enrolled prospectively.The patients presented with transient ischemic attack or acute ischemic stroke(AIS).Magnetic resonance angiography showed that the ipsilateral MCA had stenosis of 50%-99%,and it was identified as the responsible lesion.Routine MRI and the vessel wall imaging at the narrowest part of MCA were performed.The characteristics of vessels and plaques at MCA stenosis were compared between the AIS group and the non-AIS group.Multivariate logistic regression analysis was used to determine the independent risk factors for AIS.Receiver operating characteristic(ROC)curve was used to determine the predictive value of vessel wall characteristics for AIS.Results A total of 65 patients with ischemic cerebrovascular disease and MCA stenosis were enrolled.The age of patients was 68±14 years,50 were males(76.9%).There were 30 patients(46.2%)in the AIS group and 35(53.8%)in the non-AIS group.There were no significant differences in demographic data,vascular risk factors and routine laboratory tests between the two groups.Compared with the non-AIS group,the narrowest lumen area in the AIS group(2.36±1.09 mm2vs.2.96±1.01 mm2;t=2.274,P=0.027)was smaller,the plaque area(4.46±2.08 mm2vs.2.62±1.32 mm2;t=4.315,P<0.001)was larger,the remodeling index(1.08±0.11 vs.0.94±0.10;t=5.573,P<0.001)was higher,and the proportion of obvious enhanced plaque(63.3%vs.11.4%;χ2=19.034,P<0.001)and positive remodeling plaque(80.0%vs.20.0%;χ2=23.311,P<0.001)were higher.Multivariate logistic regression analysis showed that plaque area(odds ratio[OR]2.01,95%confidence interval[CI]1.35-2.98;P=0.001),remodeling pattern(OR 16.00,95%CI

关 键 词：颅内动脉硬化 大脑中动脉 卒中 脑缺血 磁共振成像 磁共振血管造影术 斑块 动脉粥样硬化 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]