基底动脉重构模式与急性脑梗死相关性的高分辨率MRI研究  

MRI study of correlation between basilar artery remodeling pattern and acute cerebral infarction

作　　者：杨立祥 崔英哲[1] 刘鹏飞[1] YANG Li-xiang;CUI Ying-zhe;LIU Peng-fei(Department of Magnetic Resonance,The First Affiliated Hospital of Harbin Medical University,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院磁共振科,黑龙江哈尔滨150001

出　　处：《影像诊断与介入放射学》2021年第6期419-424,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的研究基底动脉重构模式与斑块特征的关系以及与急性脑梗死的相关性。方法回顾性分析2018年6月~2021年8月在3.0 T MRI扫描仪行高分辨率磁共振成像(HR-MRI),诊断为基底动脉狭窄的86例患者临床和影像学资料,其中梗死组39例,非梗死组47例,正性重构组(PR)组40例(51.16%),非正性重构组(Non-PR)组46例(48.83%)。比较梗死组与非梗死组、PR组与Non-PR组基底动脉管壁狭窄的平扫T1WI VISTA、增强后T1WI VISTA,并分析重构模式与急性脑梗死之间的关系。结果梗死组正性重构(61.70%比21.27%,P<0.001)、斑块内出血(IPH)(41.03%比4.26%,P<0.001)、明显强化(58.97%比17.02%,P<0.001)、斑块大小(7.07±3.44比5.01±3.91,P<0.001),斑块负荷(28.72±10.99比20.96±14.33,P=0.007)等指标均明显高于非梗死组。PR组斑块内出血(37.50%比6.52%,P<0.001)、明显强化(52.50%比21.74%,P<0.001)高于Non-PR组(P<0.001)、斑块大小(8.24±2.60比3.95±3.61,P<0.001)、斑块负荷(32.46±8.86比17.54±12.90,P<0.001)高于Non-PR组(P<0.001)。多变量分析结果显示,斑块内出血是急性脑梗死的最强独立斑块特征[优势比(95.00%置信区间):18.408(2.758,122.871);P=0.003]。斑块明显强化与急性脑梗死相关[优势比:8.459(2.321,30.831);P=0.001]。正性重构也与急性脑梗死相关[优势比:5.761(1.362,24.366);P=0.017]。正性重构诊断急性脑梗死的敏感度74.4%,特异度76.6%,ROC曲线下面积为0.755。结论正性重构较非正性重构管壁出现更多的斑块明显强化和IPH,管壁正性重构与急性脑梗死相关。Objective To study the relationship between basilar artery remodeling pattern and plaque characteristics in correlation with acute cerebral infarction.Methods 86 patients with basilar artery stenosis admitted to our hospital from June 2018 to August 2021 underwent high-resolution 3.0 T MRI.The unenhanced and enhanced T1 VISTA of basilar artery stenosis were compared between the 39 patients(45.35%)with and the 47 patients(54.65%)without infarct,between 40 patients(51.16%)with positive remodeling(PR)and 46 patients(48.83%)without PR(non-PR)The relationship between remodeling pattern and acute cerebral infarction was analyzed.Results In 39 patients with acute infarct,PR(61.70%),intraplaque hemorrhage(IPH,41.03%),significant plaque enhancement(58.97%),plaque size(7.07),and plaque load(28.72±10.99)were significantly greater(P<0.001,P<0.001,P<0.001,P<0.001,P=0.007)than those of 37 patients without infarct(21.27%,4.26%,17.02%,5.01,20.96±14.33).In the 40 patients with PR,IPH(37.50%),significant plaque enhancement(52.50%),plaque size(8.24±2.60),and plaque load(32.46±8.86)were significantly greater(all P<0.001)than that of non-PR patients(6.52%,21.74%,3.95±3.61,17.54±12.90).Multivariable analysis of acute cerebral infarction showed that IPH was the strongest independent plaque feature of acute cerebral infarction with odds ratio of 18.408 and 95%confidence interval of 2.758-122.871(P=0.003).Significant plaque enhancement was associated with acute cerebral infarction with odds ratio of 8.459 and 95%confidence interval of 2.321-30.831(P=0.001).PR was also associated with acute cerebral infarction with odds ratio of 5.761 and 95%confidence interval of 1.362-24.366(P=0.017).The diagnostic value of PR in patients with acute cerebral infarction was 74.4%sensitive and 76.6%specific with 0.755 area under the receiver operating characteristic curve.Conclusion Basilar artery PR is associated with acute cerebral infarction and shows more plaque enhancement and IPH than non-PR.

关 键 词：基底动脉 磁共振成像 脑梗死 动脉重构 

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]