目的：探讨颅脑MRI液体衰减反转恢复序列血管高信号（fluid-attenuated inversion recovery vascular hyper-intensity, FVH）在颈动脉系统短暂性脑缺血发作（transient ischemic attack, TIA）临床意义，分析FVH阳性的相关因素。方法连续收集2012年1月至2014年2月在中国医科大学附属盛京医院神经内科住院的颈动脉系统TIA患者的临床资料，包括一般资料及TIA相关危险因素，全部患者均在发病后72 h内行颅脑MRI及MRA检查，包括FLAIR及弥散加权序列（diffusion weighted imaging，DWI）；对全部患者随访1个月，根据临床表现及头部磁共振弥散成像比较梗死组与非梗死组危险因素及FVH情况。结果142例平均年龄（63.2±11.5）岁患者中，男87例（61.27%），FVH阳性患者57例（40.14%），多元Logistic回归分析发现颈动脉系统颅内段大血管局限性狭窄≥50%(OR=2.44，95%CI：1.09～5.49，P=0.03)以及既往缺血性卒中病史(OR=3.88，95%CI：1.04～14.5，P=0.04)与FVH阳性独立相关。随访1个月，142例患者中进展为急性脑梗死40例（28.17%），脑梗死组症状对侧的颈部动脉易损斑块数(P=0.018)、对侧MRA显示颅内大血管狭窄≥50%(P=0.007)及对侧FVH出现率(P=0.001)显著高于非脑梗死组的患者。结论FVH在颈动脉系统TIA患者颅脑MRI中常见，其出现与颈动脉系统颅内段大血管局限性狭窄及既往缺血性卒中病史相关；TIA症状对侧的颈部动脉易损斑块数、对侧颅内大血管狭窄≥50%及对侧FVH出现率可能与颈动脉系统TIA短期进展为急性梗死相关。%Objective To investigate clinical significance and related factors of fluid-attenuated inversion recov⁃ery vascular hyperintensities (FVH) in transient ischemic attack (TIA) of carotid system. Method Data including general information and TIA risk factors was continuously collected from 142 patients with carotid system TIA from the depart⁃ment of neurology of Sheng jing Hospital affiliated China Medical University from January 2012 to February 2014.All pa⁃tients completed brain MRI including FLAIR and diffusion-weighted imaging (DWI)and MRA examinations within 72 hours after TIA. All patients were followed up for one month. Risk factors and FVH situations were analyzed based on clinical manifestations and DWI results. Result There were 87 male cases (61.27%)and FVH positive 57 cases (40.14%) among 142 cases with carotid system TIA (mean age 63.2±11.5). Logistic regression analysis revealed that the large intra⁃cranial carotid artery stenosis≥50%(OR=2.44,95%CI:1.09~5.49, P=0.03) and prior history of ischemic stroke (OR=3.88,95%CI:1.04~14.5, P=0.04) were independently associated with positive FVH. At one month followed-up, 40 cas⁃es (28.17%) of 142 patients progressed to acute cerebral infarction. Vulnerable plaque number in the contralateral carot⁃id artery (P=0.018), contralateral intracranial large vessel stenosis in MRA≥50%(P=0.007) and contralateral FVH oc⁃currence rate (P=0.001) were significantly higher in cerebral infarction group than in non-cerebral infarction group. Con⁃clusion FVH is common in carotid TIA patients, which is associated with intracranial carotid artery stenosis ischemic and previous history of ischemic stroke. Vulnerable plaque number of contralateral carotid artery, contralateral intracranial large vessel stenosis≥50%and the rate of occurrence of contralateral FVH may be associated with short-term progress leading TIA to acute infarction.
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