症状性颅内动脉粥样硬化性狭窄的血管重构模式与斑块特征的高分辨磁共振研究  

High-resolution magnetic resonance imaging study of vascular remodeling patterns and plaque characteristics of symptomatic intracranial atherosclerotic stenosis

作　　者：焦萌 李昂 JIAO Meng;LI Ang(Department of Diagnostic Radiology,Qinhuai Hospital,Eastern Theater Command General Hospital,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院秦淮院区放射诊断科,江苏南京210002

出　　处：《生物医学工程与临床》2023年第6期747-752,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的探索症状性颅内动脉粥样硬化性狭窄(ICAS)患者特征及高分辨磁共振成像(hr-MRI)影像特征与血管重构之间的关系。方法选择2015年1月至2019年1月在东部战区总医院神经内科因缺血性脑卒中或短暂性脑缺血发作就诊ICAS患者80例,其中男性27例,女性53例;年龄39~67岁,平均年龄53.2岁;身体质量指数(BMI)22~29 kg/m^(2),平均BMI 25.75 kg/m^(2);既往高血压史53例,糖尿病14例。行hr-MRI检查,检查序列包括弥散加权成像(DWI)、时间飞跃法磁共振血管造影(3D TOF-MRA)、平扫和增强的血管横断面液体衰竭反转恢复序列(FLAIR)T1和T2加权成像(qir-T1WI,qir-T2WI)、3D-cube序列。由2名独立影像医师,根据重构指数是否≥1.05将患者分为正性重构组和非正性重构组。比较两组间临床资料及hr-MRI特征之间的差异。结果80例ICAS患者中正性重构组48例(60%),非正性重构组32例(40%)。两组临床资料组间比较,正性重构组患者的年龄更大[(58.04±9.78)岁vs(45.97±11.72)岁。P<0.05]。hr-MRI对颅内动脉管壁及斑块形态指标分析显示,正性重构组强化指数更低(0.83±0.54 vs 1.12±0.57。P=0.021),斑块面积更大[(7.95±4.56)mm^(2)vs(2.91±2.66)mm^(2)。P<0.001]。hr-MRI对颅内动脉管壁及斑块形态指标单因素Logistic回归分析显示,正性重构组强化指数更低,斑块面积更大,狭窄程度更低,且更容易发生在后循环。后经多因素分析显示,年龄[校正比值比(OR)=1.092,95%可信区间(CI)1.014~1.176,P=0.02]和狭窄程度(校正OR=0.932,95%CI 0.887-0.980,P=0.006)均与正性重构独立相关。结论症状性ICAS的对颅内动脉血管重构模式与年龄有一定关联,通过hr-MRI确定对颅内动脉血管重构模式对ICAS脑卒中的防治具有重要意义。Objective To explore the characteristics of patients with symptomatic intracranial atherosclerotic stenosis(ICAS)and the relationship between high-resolution magnetic resonance imaging(hr-MRI)features and vascular remodeling.Methods From January 2015 to January 2019,a total of 80 ICAS patients with ischemic stroke or transient ischemic attack were enrolled,which included 27 males and 53 females,aged 39-67 years old with mean age of 53.2 years old;body mass index(BMI)22-29 kg/m^(2)with mean BMI of 25.75 kg/m^(2).There were 53 cases of hypertension and 14 of diabetes.All of them performed hr-MRI examination,which included diffusion weighted imaging(DWI),three dimensional time of flight magnetic resonance angiography(3D TOF-MRA),plain and enhanced vascular cross-sectional fluid-attenuated inversion recovery(FLAIR)T1 and T2 weighted imaging(qir-T1WI,qir-T2WI),and 3D-cube sequence.All of them were divided into positive remodeling group and non-positive remodeling group by 2 independent radiologists according to whether remodeling index was≥1.05.The differences of clinical data and hr-MRI features between 2 groups were compared.Results There were 48 cases(60%)in positive remodeling group and 32 cases(40%)in non-positive remodeling group.The comparison between 2 groups of clinical data showed that the patients in positive remodeling group were older[(58.04±9.78)years old vs(45.97±11.72)years old.P<0.05].The analysis of hr-MRI on intracranial arterial wall and plaque morphology showed that the enhancement in dex of positive remodeling group was significantly lower(0.83±0.54 vs 1.12±0.57.P=0.021),and plaque area was significantly larger[(7.95±4.56)mm^(2)vs(2.91±2.66)mm^(2).P<0.001]than non-positive remodeling group.The single factor Logistic regression analysis of intracranial artery wall and plaque morphology index by hr-MRI showed that positive remodeling group had lower enhancement index,larger plaque area,lower stenosis degree,and more likely occurred in posterior circulation than that of non-positive remodeli

关 键 词：颅内动脉粥样硬化性狭窄 高分辨磁共振成像 颅内动脉 血管重构 

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]