症状性动脉粥样硬化性大脑中动脉闭塞患者卒中复发的高分辨率磁共振成像研究  

High-Resolution Magnetic Resonance Imaging Studies of Stroke Recurrence in Patients with Symptomatic Atherosclerotic Middle Cerebral Artery Occlusion

作　　者：王倩倩 张东升 高洁 严雪娇 李玲[1] 文玉 汤敏[1] 张小玲[1] WANG Qianqian;ZHANG Dongsheng;GAO Jie(Department of MRI,Shaanxi Provincial People's Hospital,Xi’an,Shaanxi Province 710068,P.R.China)

机构地区：[1]陕西省人民医院核磁共振室,西安710068

出　　处：《临床放射学杂志》2025年第2期220-225,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目(编号:82170820);陕西省重点研发计划项目(编号:2018ZDXM-SF-038);陕西省社会发展科技攻关项目(编号:2023-YBSF-579)。

摘　　要：目的基于高分辨率磁共振成像(HR-MRI)探索症状性动脉粥样硬化性大脑中动脉闭塞(sAMCAO)患者卒中复发的影像特征。方法回顾性分析sAMCAO并接受HR-MRI检查的患者,依据6个月的随访结果分为复发组和未复发组,比较两组的斑块特征、深部微小血流空洞(DTFV)、残端状态及Willis环完整性。采用多因素Logistic回归分析与卒中复发相关的危险因素。结果共纳入88例患者,复发组22例,未复发组66例。两组患者间既往卒中及出院时改良Rankin量表(mRS)评分有统计学差异(P<0.05)。与未复发组相比,复发组的斑块内出血(26%vs.59%,P=0.004)、斑块强强化(30%vs.72%,P=0.002)、DTFV(89%vs.50%,P<0.001)及Willis环前循环不完整(21%vs.64%,P=0.001)与卒中复发显著相关。多因素Logistic回归分析显示,斑块强化程度(OR=3.504,95%CI:1.222~13.77,P=0.037)、Willis环前循环不完整(OR=8.917,95%CI:2.070~49.57,P=0.006)以及DTFV(OR=0.095,95%CI:0.014~0.461,P=0.006)与卒中复发独立相关。结论斑块强化、Willis环前循环不完整以及闭塞段周围缺乏DTFV的HR-MRI成像特征是sAMCAO卒中复发的独立危险因素。Objective To investigate the imaging characteristics associated with stroke recurrence in patients suffering from symptomatic atherosclerotic middle cerebral artery occlusion(sAMCAO)through the use of high-resolution magnetic resonance imaging(HR-MRI).Methods Patients with sAMCAO who underwent HR-MRI were retrospectively analyzed and categorized into a recurrence group and a non-recurrence group based on 6-month follow-up results.Plaque characteristics,deep tiny flow voids(DTFV),residual status,and collateral circulation integrity were compared between the two groups.Multivariate Logistic regression analysis was employed to identify risk factors associated with stroke recurrence.Results A total of 88 patients were included,with 22 in the recurrence group and 66 in the non-recurrence group.Statistically significant differences in prior stroke and mRS scores at discharge were observed between the two groups(P<0.05).Compared to the non-recurrence group,the recurrence group had significantly higher rates of intraplaque hemorrhage(26%vs.59%,P=0.004),plaque enhancement(30%vs.73%,P=0.002),DTFV(89%vs.50%,P<0.001),and incomplete anterior circulation of the Willis circle(21%vs.64%,P=0.001).Multivariate logistic regression analysis revealed that plaque enhancement(OR=3.504,95%CI:1.222-13.77,P=0.037),incomplete anterior circulation of the Willis circle(OR=8.917,95%CI:2.070-49.57,P=0.006),and deep tiny flow voids(OR=0.095,95%CI:0.014-0.461,P=0.006)were independently associated with stroke recurrence.Conclusion Plaque enhancement,incomplete anterior circulation of the Willis circle,and the absence of DTFV around the occluded segment are identified as independent risk factors for recurrent symptomatic atherosclerotic middle cerebral artery occlusive stroke.

关 键 词：脑卒中 大脑中动脉闭塞 复发 斑块特征 高分辨率磁共振成像 

分 类 号：R73[医药卫生—肿瘤]