桥脑梗死高分辨率磁共振基底动脉管壁成像研究

摘要

Objective Atherosclerotic plaques in basilar arteries of isolated pontine infarction were investigated by high-resolution magnetic resonance imaging ( HR-MRI). Methods Patients suffered from isolated pontine infarction who were underwent high resolution magnetic resonance imaging of basilar arteries in our stroke center were analyzed. To exam-ine the BA basilar artery wall,3. 0T HR-MRI sequences including T2weighted imaging (T2WI),T1weighted imaging (T1WI) and T1enhancement scanning were performed. The plaque and its characteristics of basilar artery at the maximal stenosis between PPI (paramedian pontine infarction) and SDPI ( small deep pontine infarction),were analyzed and com-pared. Results Included in this study were 55 patients with acute isolated pontine infarction,37 with PPI and 18 with SD-PI. The rates of basilar arterial atherosclerotic stenosis (≥50% ) were 58. 8% and 38. 9% ,respectively. There was no sig-nificant difference between PPI and SDPI (P=0. 214). HR-MRI detected underlying atheromatous plaques without basilar arterial stenosis (branch atheromatous disease,BAD) in 14 of 16 patients (87. 5% ) with PPI,which was more common than that of patients with SDPI and without basilar arterial stenosis (16. 7% ,P=0. 001). Compared with patients with SD-PI,plaque enhancement in BAD was more frequently observed in PPI (35. 1% vs 5. 6% ,P=0. 018). Conclusion Basilar arterial atherosclerosis is a common cause of both PPI and SDPI. BAD with plaque enhancement is frequently detected in PPI,but few in SDPI.%目的 应用高分辨率磁共振(HR-MRI)管壁成像技术研究基底动脉粥样硬化在不同类型桥脑梗死中的作用.方法 收集长海医院收治的急性孤立性桥脑梗死行3. 0T HR-MRI基底动脉管壁成像检查患者,桥脑梗死分为桥脑旁中央梗死(PPI)和深部小梗死(SDPI).所有患者均行3D-TOF MRA和HR-MRI管壁T1WI、T2WI和T1WI增强序列扫描,对比研究PPI和SDPI患者基底动脉是否存在斑块及斑块特征.结果 55例急性桥脑梗死患者纳入本研究,其中PPI组37例,SDPI组18例. 3D TOF MRA显示PPI组和SDPI组基底动脉狭窄50%以上分别为21例(58. 8% )和7例(38. 9% ),两组无统计学差异(P=0. 214). PPI组16例基底动脉狭窄小于50% ,其中14例(87. 5% )HR-MRI检测出基底动脉斑块形成,为分支动脉粥样硬化病(BAD),明显高于SDPI组(27. 3% ),两组差异具有统计学意义(P=0. 001),BAD斑块强化分别占PPI组和SDPI组中35. 1%和5. 6% ,两组比较具有统计学意义(P=0. 018).结论 HR-MRI基底动脉管壁成像研究显示动脉粥样硬化是PPI和SDPI的常见原因,BAD不稳定斑块常见于PPI,而SDPI中少见.