症状性大脑中动脉粥样硬化狭窄患者DWI与HRMR-VWI特征分析:青年与中老年组的比较  

Characteristic analysis of DWI and HRMR-VWI in patients with symptomatic middle cerebral atherosclerotic stenosis:comparison between the young group and middle-aged and elderly group

作　　者：吕霞[1] 赵家欣 马泽兰 刘岘[1] 刘国清[1] LÜXia;ZHAO Jiaxin;MA Zelan;LIU Xian;LIU Guoqing(Department of Radiology,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院影像科,广州510120

出　　处：《磁共振成像》2022年第1期1-5,10,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:81801688)。

摘　　要：目的基于扩散加权成像(diffusion weighted imaging,DWI)及高分辨磁共振血管壁成像(high resolution magnetic resonance vessel wall imaging,HRMR-VWI)探讨不同年龄段症状性大脑中动脉粥样硬化性狭窄(symptomatic middle cerebral atherosclerotic stenosis,sMCAS)患者在卒中机制及责任血管管壁特征的差异。材料与方法连续纳入2019年8月至2021年4月因sMCAS导致缺血性卒中或短暂性缺血发作的患者,根据年龄分为青年组(≤45岁)和中老年组(>45岁)。根据DWI急性脑梗死灶的分布模式判定sMCAS卒中机制,包括穿支动脉受累组、低灌注组、动脉-动脉栓塞组及多种机制组。分析两组患者在危险因素方面和卒中机制的差异,以及责任血管在HRMR-VWI管壁特征的差异,包括斑块面积、负荷、长度、强化模式、斑块内出血、斑块分布模式及责任血管的狭窄率、重构指数、重构模式。结果纳入sMCAS患者103例,其中青年患者30例,中老年患者73例,两组患者在高血压和冠心病方面差异有统计学意义(P<0.05);青年组和中老年组的卒中机制差异无统计学意义(P>0.05)。两组患者责任血管在HRMR-VWI管壁特征的比较:中老年组的斑块面积、斑块负荷及血管重构指数均大于青年组,差异有统计学意义(P<0.05);两组患者在斑块长度、斑块强化模式、斑块内出血、斑块分布及血管狭窄率、重构模式上差异无统计学意义(P>0.05)。结论青年组和中老年组sMCAS患者在斑块面积、斑块负荷及血管重构指数存在差异,提示青年sMCAS的病理生理学改变有所不同,其干预策略可能有别于中老年患者。Objective:To investigate the differences of the characteristics of responsible vessel wall between young and middle-aged and elderly patients with symptomatic middle cerebral atherosclerotic stenosis(sMCAS)based on high resolution magnetic resonance vessel wall imaging(HRMR-VWI).Materials and Methods:From August 2019 to April 2021,consecutive patients with ischemic stroke or transient ischemic attack caused by sMCAS were selected and divided into young group(≤45 years old)and middle-aged and elderly group(>45 years old).The mechanism of sMCAS stroke was determined according to the distribution pattern of acute cerebral infarction on DWI,including parent artery occluding penetrating artery,hypoperfusion,artery-artery embolization and multiple mechanism.The differences of risk factors between the two groups and the differences of HRMR-VWI wall characteristics of responsible vessels were analyzed,including plaque area,plaque burden,length,enhancement pattern,intraplaque bleeding,plaque distribution pattern,stenosis rate of responsible vessels,remodeling index and remodeling pattern.Results:One hundred and three patients with sMCAS were included,including 30 young patients and 73 middle-aged and elderly patients.There were significant differences in hypertension and coronary heart disease between the two groups(P<0.05);there was no significant difference in the mechanism of sMCAS stroke between the two groups(P>0.05).The plaque area,plaque burden and vascular remodeling index of the middle-aged and elderly group were higher than those of the young group(P<0.05);there was no significant difference in plaque length,plaque enhancement pattern,intraplaque bleeding,plaque distribution,stenosis rate and remodeling pattern between the two groups(P>0.05).Conclusions:There are differences in plaque area,plaque burden and vascular remodeling index between young and middle aged-elderly patients with sMCAS,suggesting that the pathophysiological changes of young patients with sMCAS are different,and their intervention strategie

关 键 词：扩散加权成像 高分辨磁共振血管壁成像 大脑中动脉 动脉粥样硬化 年龄 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]