高分辨磁共振影像在青年卒中的临床诊断价值  

The diagnostic value of high-resolution magnetic resonance in young stroke patients

作　　者：袁伟壮 李明利 冯逢[2] 高山[1] 徐蔚海[1] YUAN Weizhuang;LI Mingli;FENG Feng(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经科,北京100730 [2]中国医学科学院北京协和医院影像科,北京100730

出　　处：《中风与神经疾病杂志》2021年第11期984-989,共6页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探索高分辨磁共振(High-resolution magnetic resonance imaging,HRMRI)对青年卒中病因诊断的临床应用价值。方法回顾性纳入在2016年1月1日至2020年12月31日在北京协和医院住院的缺血性脑卒中或短暂性脑缺血发作的青年患者(≤55岁),收集其临床资料和影像学特征,将是否完善HRMRI分成两组,计算两组患者的临床特征、卒中病因及不明原因卒中占比的差异。并进一步计算HRMRI组在检查前后不明原因卒中占比的变化,得出修正诊断和精确诊断的病因变化。结果本研究共纳入病例155例,73例(47.1%)进行了HRMRI检查,82例(52.9%)未进行HRMRI检查。除HRMRI组年龄略低于未进行HRMRI组外(40.36 VS 43.89,P=0.026),性别、危险因素、家族史均无明显差异。HRMRI组不明原因卒中的比率少于未进行HRMRI检查组(16.4%VS 26.8%,P=0.119)。在传统影像和检查方法的基础上,29%(20例)的患者在HRMRI后诊断得到修正或者精确,使不明原因卒中减少7%,在小于35岁的患者中,45.8%得到诊断的修正和精确。病因诊断的变化主要是将不明原因卒中修正为大动脉粥样硬化型(5例,5/20),以及大动脉粥样硬化型修正为其他血管病如动脉夹层(5例,5/20)。此外,在所有完善HRMRI的患者中,HRMRI总共检出斑块43例(58.9%),其中9例(20.9%)为易损斑块,4例(9%)发现为斑块斑块阻塞穿支口。其他病因方面,发现壁内血肿7例,占9.6%,血管炎表现3例,占4.1%,烟雾病表现为5例(6.8%)。结论在使用HRMRI后,超过四分之一的青年卒中病例得到修正诊断或精准诊断。应进一步在青年卒中患者中普遍应用这一技术。Objective This study is aimed to explore the value of high-resolution magnetic resonance(HRMRI)in the diagnosis of the etiology of stroke in young adults.Methods We retrospectively enrolled ischemic stroke or transient ischemic attack patients who≤55 years old admitted in Peking Union Medical College Hospital from January 1,2016 to December 31,2020.Patients were separated into two groups:with or without HRMRI.After collecting the baseline data,clinical features,and imaging characteristics,we explore the differences in the clinical characteristics,the etiology of stroke,and the proportion of cryptogenic stroke between the two groups.The changes of cryptogenic stroke proportion in the HRMRI group before and after HRMRI were further calculated,and the changes of the revised diagnosis were also obtained.Results A total of 155 cases were included in the study.Of those,73 cases(47.1%)underwent HRMRI,while 82 cases(52.9%)did not.HRMRI group was slightly younger than the non-HRMRI group(40.36 VS 43.89,P=0.026),while there were no significant differences in gender,risk factors,and family history.The cryptogenic stroke proportion in the HRMRI group was lower than that in the group without HRMRI(16.4%VS 26.8%,P=0.119).29%of patients were corrected or make more accurate the diagnosed with the help of HRMRI,reducing cryptogenic stroke by 7%.The changes in the etiology diagnosis mainly from cryptogenic stroke to atherosclerosis disease(5,5/20),and also from other vascular diseases such as arterial dissection to atherosclerosis disease(5,5/20).Conclusion With HRMRI,nearly one-third of young stroke has revised or accurate for their diagnosis,and the remaining has confirmed for their diagnosis.This technique should be widely used in young stroke patients.

关 键 词：高分辨磁共振 管壁磁共振 青年卒中 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]