磁共振血管壁成像评估大脑中动脉粥样硬化斑块与复发性卒中相关性研究  

Correlation study of atherosclerotic plaques in the middle cerebral artery with recurrent stroke assessed by magnetic resonance vascular wall imaging

作　　者：温馨如 林国辉 宋建勋[1] WEN Xinru;LIN Guohui;SONG Jianxun(Room of MR,Shenzhen Baoan People's Hospital,Shenzhen 518100,China)

机构地区：[1]深圳市宝安区人民医院核磁共振室,深圳518100

出　　处：《磁共振成像》2025年第4期25-32,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：深圳市科技创新计划项目可持续发展项目(编号:KCXFZ202002011010360)。

摘　　要：目的 应用磁共振血管壁成像(magnetic resonance vascular wall imaging,MR-VWI)检查,对大脑中动脉区域缺血性脑卒中患者颅内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 回顾性选取于我院就诊的大脑中动脉粥样硬化患者共185例,所有患者均完成MR-VWI检查并判定梗死区域大脑中动脉内存在责任斑块,并根据临床及影像资料将患者分为三组,分别为首发卒中组、复发卒中组以及卒中阴性组。记录斑块特征、中国缺血性卒中分型亚型(China Ischemic Stroke Subclassification,CISS)以及其他影像学指标。比较三组患者的临床资料及影像特征的差异性,进一步采用logistic回归分析,筛选与缺血性卒中复发相关的危险因素。对多因素分析得到的独立相关因素计算受试者工作特征曲线相应的曲线下面积(area under the curve,AUC)。结果 共纳入185例患者,首发卒中组69例,复发卒中组76例,卒中阴性组40例。三组间性别(P>0.05)差异无统计学意义。与首发卒中组与卒中阴性组相比,复发卒中组的患者年龄更大(P<0.05),糖尿病患病比例更高(P<0.05)。与卒中阴性组相比,首发卒中组与复发卒中组大于45岁的中老年患者比例更大(P=0.006、P<0.001),复发卒中组糖尿病患病比例(P=0.013)更高。与卒中阴性组相比,首发卒中组患者以环壁斑块多见(P=0.008);首发卒中组与复发卒中组的斑块面积、斑块负荷及狭窄程度更大、强化的斑块数量更多(P<0.05)。首发卒中组与复发卒中组相比,复发卒中组的卒中机制更倾向于CISS分型中的低灌注/栓子消除障碍类型(P=0.046),复发卒中组具有更大的斑块面积(P<0.001)、斑块负荷(P<0.001)、更明显的狭窄程度(P<0.001)。多因素逻辑回归分析显示,年龄、斑块面积、斑块负荷是大脑中动脉区域内缺血性卒中复发相关的独立危险因素(P<0.05),年龄[比值比(odds ratio,OR)=1.04Objective:Magnetic resonance vascular wall imaging(MR-VWI) was used to analyze the characteristics of intracranial atherosclerotic plaques in patients with ischemic stroke in the middle cerebral artery region,and to explore the imaging features independently associated with recurrent stroke.Materials and Methods:A total of 185 patients with middle cerebral artery atherosclerosis were retrospectively selected from our hospital.All patients completed MR-VWI examination and were determined to have responsible plaque in the middle cerebral artery in the infarction area.According to the clinical and imaging data,the patients were divided into three groups,namely the first stroke group,the recurrent stroke group and the negative stroke group.Plaque characteristics,China Ischemic Stroke Subclassification(CISS),and other imaging indicators were recorded.The differences of clinical data and imaging features among the three groups were compared,and the risk factors related to ischemic stroke recurrence were further screened by logistic regression analysis.The area under the curve(AUC) corresponding to the receiver operating characteristic curve was calculated for the independent correlation factors obtained from the multi-factor analysis.Results:A total of 185 patients were included,including 69 patients in the first stroke group,76 patients in the recurrent stroke group and 40 patients in the negative stroke group.There was no significant difference in gender among the three groups(P > 0.05).Compared with the first stroke group and the stroke negative group,patients in the recurrent stroke group were older(P < 0.05) and had a higher proportion of diabetes(P < 0.05).Compared with the negative stroke group,the proportion of middle-aged and elderly patients over 45 years old in the first stroke group and the recurrent stroke group was higher(P = 0.006,P< 0.001),and the proportion of diabetes in the recurrent stroke group was higher(P = 0.013).Ring-wall plaques were more common in the first stroke group than in the negative s

关 键 词：缺血性卒中 卒中复发 磁共振成像 血管壁成像 斑块 

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