高分辨率磁共振大脑中动脉粥样硬化斑块的分布及信号特点与脑梗死的关系

摘要

Objective:To investigate the correlation between the distribution and signal intensity of middle cerebral artery (MCA) atherosclerotic plaques and acute infraction using high-resolution magnetic resonance imaging.Materials and Methods:Thirty-two consecutive symptomatic patients with atherosclerotic MCA stenosis were imaged with a 3.0 T magnetic resonance scanner.The HR MRI protocol included T1-weighted,T2-weighted black blood imaging.The patients were divided into acute infarction group and non-acute infarction group,according to hyperintense on DWI or not.The locations of plaques were classified into ventral wall,inferior wall,dorsal wall,superior wall.Signal intensity of plaques were recorded as hyperintense or mixed singal intense.Results:Thirty-two cases were enrolled.13 plaques were located at the ventral wall,7 at the inferior wall,4 at the dorsal wall,4 at the superior wall,and 4 with lumen occlusion.The acute infarction in corresponding place were 2,2,3,4.The plaques located at dorsal or superior wall were more susceptible to acute infarction (P=0.002).There were 8 plaques with hyperintense or mixed singal intense (SI) on T1WI or T2WI in acute infarction group,while 2 plaques like that in non-acute infarction group,the difference had statistical significance (P=0.021).Conclusions:Middle cerebral artery atherosclerotic plaques have certain tendency to locate at ventral and inferior wall,but plaques at dorsal or superior wall were more susceptible to acute infarction.The plaques with hyperintense or mixed singal intense were more likely to occur in acute infarction cases.%目的 用高分辨率磁共振成像方法,探讨大脑中动脉(middle cerebral artery,MCA)粥样硬化斑块的分布和信号特点与急性脑梗死之间的相关性.材料与方法 搜集2015年8月至2016年4月南京市第一医院神经内科32例有临床症状的MCA粥样硬化狭窄的病人,进行常规头颅MR扫描和MCA狭窄处黑血技术T1WI、T2WI扫描.将动脉粥样硬化斑块的分布位置分为前壁、下壁、后壁、上壁;依据弥散加权图像上MCA供血区有无高信号分为急性脑梗死、无急性脑梗死.统计斑块的好发部位;比较急性脑梗死与无急性脑梗死之间高信号或混杂信号斑块数目的差异.结果 32例图像用于分析,斑块的分布情况为前壁13例、下壁7例、后壁4例、上壁4例,余4例为管腔完全闭塞,各分布部位的相应急性脑梗死例数为2、2、3、4,位于上壁或后壁的斑块较前壁或下壁斑块更易引起急性脑梗死,差异有统计学意义(P=0.002);急性脑梗死1 5例,T1WI或T2WI表现为高信号或混杂信号的有8例;无急性脑梗死17例,T1WI或T2WI表现为高信号或混杂信号的有2例,两者间差异具有统计学意义(P=0.021).结论 大脑中动脉粥样硬化斑块好发于血管前壁、下壁,但位于上壁或后壁斑块更易引发脑梗死;高信号或混杂信号斑块更多见于急性脑梗死患者,可能与其不稳定性有关.