T2 FLAIR高信号血管征在缺血性脑血管病中的发生规律及价值

摘要

目的：探讨T2 FLAIR高信号血管征（FLAIR vasclucar hyperintensity，FVH）在缺血性脑血管病中的发生规律及价值。方法：回顾性分析120例经临床诊断为缺血性脑血管病患者的MRI表现，包括FVH征、责任侧血管狭窄程度、脑白质疏松（leukoaraiosis，LA）程度以及梗死区大小（ASPECT评分）。采用Spearman等级相关分析FVH征与血管狭窄程度及LA程度之间的关系；利用字2检验对照分析不同血管狭窄程度（无、轻-中度狭窄、重度狭窄-闭塞）、不同脑白质疏松程度（无LA、1级、2级、3级）、不同梗死时相（亚急性脑梗死、陈旧脑梗死）之间患者脑内FVH征发生率的差异；采用秩和检验分析有FVH征组患者与无FVH征组患者ASPECT评分的差异。结果：120例缺血性脑血管疾病患者中，FVH征发生率为60.8%（73/120），其中亚急性脑梗死患者中FVH征出现率明显高于陈旧脑梗死患者（76.6%vs 51.9%，P<0.05）。FVH征与血管狭窄程度呈现低度正向相关（r=0.277，P<0.05）；在责任侧血管无狭窄、轻-中度狭窄、重度狭窄-闭塞的患者中，FVH征的发生率依次为44.0%（22/50）、71.7%（33/46）、75.0%（18/24），差异有统计学意义（P<0.01）。FVH征与LA程度也呈现低度正向相关（r=0.321， P<0.05）；在无LA、1级、2级、3级LA者FVH征发生率依次为50.0%（6/12）、42.5%（17/40）、62.5%（25/40）、89.3%（25/28），差异有统计学意义（P<0.05）。有FVH征组患者与无FVH征组患者ASPECT评分比较，差异无统计学意义（Z=-0.372，P=0.710）。结论：FVH征是颅内动脉狭窄所致缺血性脑血管病的常见征象，其发生与脑梗死时相、责任血管狭窄程度以及与微血管病变的程度存在明确的关系。%Objective:To investigate the occurrence rules and clinical value of T2 Flair vascular hyperintensity(FVH)in ischemic cerebrovascular disease.Method:A retrospective MRI findings were analyzed in 120 cases of clinically diagnosed patients with ischemic cerebrovascular disease,including FVH sign,vascular stenosis,leukoaraiosis(leukoaraiosis,LA)and infarcttion(ASPECT score).The relationship between the FVH sign and stenosis degree and then the LA grade was evaluated using Spearman rank correlation analysis.The incidence rate difference of cerebral FVH sign was assessed by chi square test between different degrees of stenosis (none,mild to moderate stenosis,severe stenosis and occlusion),and leukoaraiosis grade groups(none,grade 1,grade 2,grade 3),whileas different infarction phase(subacute and chronic infarction).Rank sum test was used to compare ASPECT score in the patients with and without FVH sign.Result:In 120 cases of ischemic cerebrovascular disease,the occurrence rate of FVH sign was 60.8%(73/120).FVH sign was increased in patients with subacute cerebral infarction than the ones with chronic infarction(76.6%vs 51.9%,P<0.05).The FVH sign is low positively correlated with the degree of vascular stenosis(r=0.277,P<0.05).The incidence rate of FVH sign was also significantly different(P<0.01)with 44.0%(22/50)for light-moderate stenosis,71.7%(33/46)for severe stenosis and 75.0%(18/24)for occlusion of the involving arteries. Slight positive correlation was also present between FVH sign and the LA grade(r=0.321,P<0.05). FVH sign incidence rate was 50.0%(6/12),42.5%(17/40),62.5%(25/40) and 89.3%(25/28)in none LA,grade 1 LA,grade 2 LA and grade 3 LA(P<0.05).There was no difference in ASPECT scores between patients with and without FVH sign(Z=-0.372,P=0.71).Conclusion:FVH is a common sign of ischemic cerebral vascular disease due to intracranial arterial stenosis,which is indeed related to the phase of cerebral infarction,the stenosis degree of involved artery and microvascular disease.