98例内分水岭脑梗死患者MRI影像学类型分布及临床特点分析  

Analysis of MRI imaging type distribution and clinical characteristics of 98 patients with internal watershed cerebral infarction

作　　者：张亮 代向党 王赢 乔继红 刘俊启[2] ZHANG Liang;DAI Xiangdang;WANG Ying;QIAO Jihong;LIU Junqi(Department of Radiology,Zhumadian Central Hospital,Zhumadian,Henan 463000,China;Department of Radiotherapy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]驻马店市中心医院放射科,河南省驻马店市463000 [2]郑州大学第一附属医院放疗科,河南省郑州市450052

出　　处：《中国动脉硬化杂志》2022年第1期49-53,共5页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金资助项目(81703158)。

摘　　要：目的探讨内分水岭脑梗死(IWSI)患者磁共振成像(MRI)影像学类型分布和临床特点。方法回顾性分析2017年6月—2018年12月间收治的98例IWSI患者临床资料,所有患者均进行MRI检查和弥散加权成像(DWI)。评估IWSI患者MRI影像学类型分布、临床特点,评估患者临床疗效[美国国立卫生研究院卒中量表(NIHSS)]及预后转归[改良Rankin量表(mRS)]。结果①融合型表现为侧脑室旁雪茄样病灶,共44例(44/98,44.90%);局灶型表现为单个类圆形病灶,共37例(37/98,37.76%);串珠型表现为脑分水岭区的多发串珠样病灶,共17例(17/98,17.35%);②IWSI患者T1WI序列呈低信号,T2WI序列呈高信号改变,部分出血性脑梗死患者T1WI序列低信号中可见有高信号改变;③融合型IWSI合并皮层分水岭脑梗死(CWSI)比例高于局灶型和串珠型IWSI(P<0.05),融合型IWSI大脑中动脉中度及以上狭窄比例小于局灶型和串珠型IWSI(P<0.05),局灶型IWSI斑块发生情况及不稳定性斑块比例均明显低于融合型、串珠型IWSI(P<0.05);④不同类型IWSI入院时NIHSS得分、好转率、随访6个月mRS得分差异均无统计学意义(P>0.05),局灶型IWSI入院1周后NIHSS得分低于融合型和串珠型IWSI患者(P<0.05)。结论IWSI患者融合型占比最高,不同影像学类型的临床特点存在差异,融合型IWSI较易合并CWSI、大脑中动脉狭窄程度更高,临床可结合MRI结果对IWSI作出相应诊断。Aim To investigate the imaging type distribution and clinical characteristics of magnetic resonance imaging(MRI)in patients with internal watershed cerebral infarction(IWSI).Methods The clinical data of 98 patients with IWSI admitted between June 2017 and December 2018 were retrospectively analyzed.All patients underwent MRI and diffusion-weighted imaging(DWI).The MRI imaging type distribution and clinical characteristics were evaluated among patients with IWSI,and the clinical efficacy(National Institutes of Health Stroke Scale(NIHSS))and prognosis and outcomes(Modified Rankin Scale(mRS))were evaluated among the patients.Results The fusion type showed periventricular cigar-like lesions,44 cases(44/98,44.90%)in total.The focal type showed single quasi-circular lesions,37 cases(37/98,37.76%)in total.Beaded type presented as multiple bead-like lesions in brain watershed area,17 cases(17/98,17.35%)in total.T1WI sequence of patients with IWSI showed low signal,and T2WI sequence showed high signal change,and T1WI sequence low signal in some patients with hemorrhagic cerebral infarction showed a high signal change.The proportion of combination of cortical watershed cerebral infarction(CWSI)of fusion IWSI was higher than that of focal and beaded IWSI(P<0.05),and the proportion of moderate or above middle cerebral artery stenosis of fusion IWSI was less than that of focal and beaded IWSI(P<0.05).The occurrence of plaques and the proportion of unstable plaques of focal IWSI were significantly lower than those of fusion and beaded IWSI(P<0.05).There were no statistically significant differences in the NIHSS scores at admission,improvement rate and mRS scores at 6 months of follow-up among different types of IWSI(P>0.05),and the NIHSS scores at 1week after admission of focal IWSI was lower than that of patients with fusion and beaded IWSI(P<0.05).Conclusions Patients with fusion IWSI have the highest proportion,and there are differences in the clinical characteristics among different imaging types.Fusion IWSI is more likely

关 键 词：内分水岭脑梗死 磁共振成像 梗死类型 临床特点 影像学表现 

分 类 号：R741[医药卫生—神经病学与精神病学]