Willis环完整性及颅颈动脉粥样硬化斑块特征与复发性卒中的相关性研究  

The recurrent stroke associated with integrity of Willis ring and characteristics of intracranial-carotid artery plaques

作　　者：王泽华 高阳[1] 吴琼[1] 何金龙[1] 王丽雯 WANG Zehua;GAO Yang;WU Qiong;HE Jinlong;WANG Liwen(Department of Radiology,the First Clinical Medical College of Inner Mongolia Medical University,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院影像诊断科,呼和浩特010050

出　　处：《磁共振成像》2023年第12期19-25,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：内蒙古自治区自然科学基金项目(编号:2023QN08055);内蒙古自治区医疗卫生科技计划项目(编号:202201250)。

摘　　要：目的使用颅颈一体化的高分辨率磁共振血管成像(magnetic resonance angiography,MRA)检查,对前循环缺血性脑卒中患者的Willis环完整性、颅颈动脉粥样硬化斑块特征进行分析,探寻与复发性卒中独立相关的影像特征。材料与方法回顾性分析前循环缺血性脑卒中患者87例,均在症状出现14 d内接受高分辨率磁共振血管壁成像检查,并根据临床及影像资料将其分为卒中初发组和复发组。记录斑块总数、颅颈动脉斑块特征及Willis环完整性。比较初发组、复发组之间及Willis环完整组、不完整组之间的颅颈动脉斑块特征。采用多因素logistic回归分析评估与前循环缺血性脑卒中复发相关的独立危险因素。结果共纳入87例患者。初发组54例,复发组33例。两组间性别(P=0.223)、年龄(P=0.779)差异无均统计学意义。与初发组相比,复发组的颅内斑块强化(P=0.010)、颅内动脉狭窄程度(P=0.002)、斑块总数(P<0.001)、颅内斑块强化合并颅外斑块(P=0.006)、颅内(或颅外)动脉狭窄>50%合并颅外(或颅内)斑块(P=0.001)及Willis环后循环症状侧不完整(P<0.001)与复发性卒中显著相关。与Willis环前循环完整组相比,Willis环前循环不完整组颅内斑块强化(P=0.012)更多见。多因素logistic回归分析显示:斑块总数[比值比(odds ratio,OR)=2.14,95%置信区间(confidence interval,CI):1.182~3.869,P=0.012]和Willis环后循环症状侧不完整(OR=4.58,95%CI:1.496~14.041,P=0.008)为前循环缺血性脑卒中复发的独立危险因素。logistic回归模型的整体预测效能最佳[曲线下面积(area under the curve,AUC)=0.811,95%CI:0.711~0.910]。结论斑块总数和Willis环后循环症状侧不完整与前循环缺血性脑卒中复发独立相关。颅颈一体化的高分辨率磁共振血管壁成像检查可为前循环缺血性脑卒中复发预测模型的构建提供新指标。Objective:The integrity of Willis ring and the characteristics of Atherosclerosis plaque in the skull and neck of patients with ischemic stroke in the anterior circulation were analyzed by using magnetic resonance angiography(MRA)integrated with the skull and neck to explore the image characteristics independently related to recurrent stroke.Materials and Methods:Eighty-seven patients with anterior circulation ischemic stroke were collected retrospectively.all of them were examined by high-resolution magnetic resonance angiography within 14 days after the onset of symptoms,and were divided into initial stroke group and recurrent group according to clinical and imaging data.They were divided into the initial stroke group and the recurrent stroke group based on clinical and imaging data.Record the total number of plaques,the characteristics of carotid artery plaques(intracranial:plaque enhancement,intra plaque bleeding,degree of stenosis;extracranial:lipid core,intra plaque bleeding,degree of stenosis),and the integrity of the Willis ring.Compare the characteristics of carotid artery plaques between the initial and recurrent groups.Evaluation of independent risk factors associated with recurrence of ischemic stroke in the anterior circulation using multivariate logistic regression analysis.Results:A total of 87 patients were included.There are 54 cases in the initial group and 33 cases in the recurrence group.There was no statistically significant difference in gender(P=0.223)and age(P=0.779)between the two groups.Compared with the initial group,the recurrent group showed intracranial plaque enhancement(P=0.010),degree of intracranial artery stenosis(P=0.002),total number of plaques(P<0.001),intracranial plaque enhancement combined with extracranial plaques(P=0.006),intracranial(or extracranial)artery stenosis>50%combined with extracranial(or intracranial)plaques(P=0.001),and incomplete symptom side of Willis'posterior circulation(P<0.001).Significant correlation with recurrent stroke.Compared with the Willis group

关 键 词：脑卒中 卒中复发 磁共振成像 血管壁成像 颅颈斑块 WILLIS环 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学] R743.3[医药卫生—临床医学]