大脑中动脉粥样硬化性急性脑卒中的斑块特征及血流动力学危险因素分析  

Analysis on the risk factors of plaque characteristics and hemodynamics in acute stroke with MCA atherosclerosis of brain

作　　者：陈禹 沈龙山[1,2,3] 陈刘成 王震寰[2,5] Chen Yu;Shen Longshan;Chen Liucheng;Wang Zhenhuan(Department of Radiology,The Second Affiliated Hospital of Bengbu Medical University,Bengbu 233040,China;Key Laboratory of Digital Medicine and Intelligent Health in Anhui General Universities(Bengbu Medical College),Institute for Clinical Applied Anatomy,Bengbu Medical College,Bengbu 233004,China;School of Medical Imaging,Bengbu Medical College,Bengbu 233030,China;Department of Radiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Teaching and Research of Human Anatomy,Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]蚌埠医学院第二附属医院放射科,蚌埠233040 [2]数字医学与智慧健康安徽普通高校重点实验室(蚌埠医学院)蚌埠医学院临床应用解剖研究所,蚌埠233004 [3]蚌埠医学院医学影像学院,蚌埠233030 [4]蚌埠医学院第一附属医院放射科,蚌埠233004 [5]蚌埠医学院人体解剖教研室,蚌埠233030

出　　处：《中国医学装备》2024年第8期46-53,共8页China Medical Equipment

基　　金：数字医学与智慧健康安徽普通高校重点实验室(蚌埠医学院)一般项目(AHCM2022W001);蚌埠医学院转化医学重点项目(BYTM2019045)。

摘　　要：目的:使用全脑管壁成像联合全脑灌注探寻引起缺血性卒中事件发生的相关高危斑块影像特征。方法:回顾性分析2021年10月至2023年3月蚌埠医学院第二附属医院就诊的60例疑似大脑中动脉(MCA)粥样硬化疾病患者,所有患者均行高分辨磁共振血管壁成像(HRMR-VWI)联合CT灌注检查,根据弥散加权成像(DWI)高信号或临床出现与MCA供血区域相关的特异性临床症状将其分为症状组(36例)和无症状组(24例),比较两组的斑块影像学特征、侧支循环状态及血流动力学变化的差异,绘制受试者工作特征(ROC)曲线显示单因素和联合诊断模型的诊断效能。结果:与无症状组相比,症状组患者的斑块更长、重构指数更大、斑块强化程度更高、斑块位于上壁和(或)后侧的更多、偏心性斑块更多、侧支循环状态更差、相对平均通过时间(rMTT)更大、相对达峰时间(rTTP)更大、相对剩余函数达峰时间(rTmax)更大。ROC曲线分析显示,上述4个指标的ROC曲线下面积(AUC)均低于4者联合诊断模型的AUC(0.911)。结论:HRMR-VWI联合CTP能够明确其在预测缺血性事件中的价值,优化基于MCA粥样硬化斑块、软脑膜侧支状态及脑灌注状态等风险因素评估体系。Objective:To use whole brain vessel wall imaging combined with whole brain perfusion to explore the relevant high-risk features of imaging that caused the occurrence of ischemic stroke events.Method:A retrospective analysis was conducted on 60 patients with suspected atherosclerosis of middle cerebral artery(MCA)who admitted to The Second Affiliated Hospital of Bengbu Medical University from Oct.2021 to Mar.2023.All patients underwent the examination of high-resolution magnetic resonance vessel wall imaging(HRMR-VWI).According to the high signal values of diffusion weighted imaging(DWI),or the specifically clinical symptoms that were relevant with MCA bloodsupplied area in clinical practice,they were divided into symptom group(36 cases)and non-symptom group(24 cases).The differences of the imaging characteristics of plaque,the status of collateral circulation and hemodynamic changes between the two groups were compared.The receiver operating characteristic(ROC)curve was drawn to appear the diagnostic efficiencies of the single factor model and the combined diagnostic model.Result:Compared with the nonsymptom group,the patients of the symptom group had longer plaques,larger remodeling index,higher degree of plaque enhancement,more plaques located on the upper or posterior wall,more eccentric plaques,poorer status of collateral circulation,larger relative mean transit time(rMTT),larger relative time to peak(rTTP),and larger relative time to peak of residual function(rTmax).ROC curve analysis showed that the area under curve(AUC)values of the above four indicators were all lower than that of the combined diagnostic models of them(0.911).Conclusion:HRMRVWI combined with compute tomography perfusion(CTP)can clarify the value of that in predicting ischemic events,and optimize the assessment system based on risk factors such as MCA atherosclerotic plaque,collateral status of leptomeningeal and cerebral perfusion status.

关 键 词：高分辨磁共振血管壁成像(HRMR-VWI) 血流动力学 大脑中动脉(MCA) 斑块 缺血性事件 

分 类 号：R445.2[医药卫生—影像医学与核医学]