大脑中动脉粥样硬化斑块易损性与脑白质高信号的相关性研究  

Magnetic resonance imaging study on the correlation of atherosclerotic plaques in the middle cerebral artery and white matter hyperintensity

作　　者：李家钰 石莹 崔英哲[1] 田园[1] 刘鹏飞[1] LI Jia-yu;SHI Ying;CUI Ying-zhe(Department of Magnetic Resonance,the First Affiliated Hospital of Harbin Medical University,Harbin 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：《放射学实践》2024年第8期998-1006,共9页Radiologic Practice

基　　金：黑龙江省卫生健康委科研课题基金(2020-099)。

摘　　要：目的:通过对比分析基于Fazekas评分的不同严重程度脑白质高信号(WMHs)患者的大脑中动脉管壁改变和斑块特征,探讨斑块易损性参数与脑白质高信号严重程度的相关性。方法:将2021年5月-2023年5月本院收治的因怀疑大脑中动脉粥样硬化斑块而行常规序列颅脑MR扫描及大脑中动脉M1段高分辨管壁成像检查的99例住院患者纳入本研究。基于颅脑MRI平扫图像,根据改良Fazekas评分标准将患者分为2组:无和轻度WMHs组(Fazekas 0~2分)57例,中重度WMHs组(Fazekas 3~6分)42例。采用两独立样本t检验、非参数Mann-Whitney U检验和卡方分析比较两组之间血管狭窄程度、斑块分布、管壁重构模式、斑块内出血和斑块负荷等易损性参数的差异。采用Spearman相关分析和二元logistic回归分析确定易损斑块与WMHs之间的关系。结果:年龄及血脂异常和斑块内出血占比在两组间的差异有统计学意义(P<0.05),中和重度WMHs组患者年龄更大,血脂异常更常见,斑块内出血比例更高。相关性分析显示,年龄,血脂异常和斑块内出血均与白质高信号等级呈正相关(r=0.276、0.215、0.321,P均<0.05)。二元logistics回归分析结果显示年龄和斑块内出血是WMHs严重程度的独立危险因素[OR=1.083(1.030,1.139),P=0.002;OR=4.991(1.459,17.072),P=0.010]。结论:年龄、血脂异常和斑块内出血与WMHs严重程度相关,年龄和斑块内出血是WMHs严重程度的独立影响因素,提示颅内大动脉粥样硬化易损性斑块与脑小血管病具有相关性,有助于指导临床制订个性化的治疗方案。Objective:The purpose of this study was to analyze the wall changes and plaque cha-racteristics of the middle cerebral artery in patients with different Fazekas degrees of severity of white matter hyperintensity(WMHs)groups,and to investigate the correlation between plaque vulnerability and different degrees of severity of cerebral white matter hyperintensity.Methods:One hundred and twenty-eight patients with suspected middle cerebral artery atherosclerotic plaques who underwent brain MRI scan and high-resolution MRI scan on the M1 segment of the middle cerebral artery from May 2021 to May 2023 in our hospital were selected.The patients were categorized into the group with no and mild WMHs(Fazekas score of 0~2)and the group with moderate and severe WMHs(Fazekas score of 3~6)according to the brain scan and modified Fazekas scoring scale(0~6 score).Two independent samples t-test,nonparametric Mann-Whitney U-test,and chi-square analysis were used to compare the differences in vulnerability parameters such as degree of stenosis,plaque distribution,wall remodeling pattern,intraplaque hemorrhage,and plaque load between the two groups.In addition,the relationship between plaque vulnerability parameters and WMHs was determined using Spearman correlation and binary logistic regression.Results:A total of 99 subjects were eligible for enrollment,57 in the group with no and mild WMHs and 42 in the group with moderate and severe WMHs.Analysis of variance showed that age,the proportion of dyslipidemia,and intraplaque hemorrhage were statistically different between the two groups(P<0.05).Patients in the moderate and severe WMHs group were older,dyslipidemia was more common,and the proportion of intraplaque hemorrhage was higher.Correlation analysis showed that age,dyslipidemia,and intraplaque hemorrhage were positively correlated with white matter hyperintensity grade(r=0.276,0.215 and 0.321,all P<0.05).Binary logistic regression showed that age and intraplaque hemorrhage were independent factors affecting the severity of WMHs[

关 键 词：脑白质高信号 脑小血管病 动脉粥样硬化斑块 磁共振成像 高分辨血管壁成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.4[医药卫生—诊断学] R743.1[医药卫生—临床医学]