高分辨磁共振对急性脑梗死患者的颅内动脉评估
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摘要
目的 通过高分辨磁共振对急性脑梗死患者的颅内动脉评估,探索脑梗死的病因。方法 纳入2017年6月-2018年6月西安交通大学第二附属医院神经内科收治的发病1 w,且完成高分辨磁共振等血管检查的急性脑梗死患者52例,收集其年龄、性别、血糖、血脂、血压、吸烟史、同型半胱氨酸资料,根据DWI弥散受限部位,通过头部MRA确定责任血管,对责任血管应用3. 0T高分辨磁共振进行扫描。根据高分辨磁共振扫描结果分为斑块阳性组和斑块阴性组,比较两组临床资料。将斑块阳性组分为前循环组和后循环组,比较两组斑块分布特点,管壁体积百分比,血管重塑指数是否有统计学差异。结果 共纳入52例急性脑梗死患者,其中经高分辨MR发现责任血管斑块阳性组34例,斑块阴性组18例。斑块阴性组中:脑动脉夹层9例(颈内动脉夹层4例,椎动脉夹层4例,基底动脉夹层1例),烟雾病2例,血管炎1例,血管无异常组6例。本研究中经高分辨MR发现的斑块阳性组中头部MRA正常者11例(11/34),头部MRA提示管腔狭窄及闭塞者23例(23/34)。斑块阳性组与斑块阴性组在高血压(P=0. 02)及年龄(P=0. 02)比较有统计学差异。动脉斑块阳性组中前循环组12例(均为大脑中动脉);后循环组22例(基底动脉19例,椎动脉3例),前循环组与后循环组两组间在斑块分布特点(P=0. 68)、管壁体积百分比(P=0. 18)、血管重塑指数(P=0. 41)比较均无统计学差异。结论 联合高分辨磁共振对于急性脑梗死患者颅内动脉的评估有助于脑梗死病因判断。前后循环在斑块的分布、管壁体积百分比、血管重塑指数方面比较无统计学差异。
Objective To evaluate the intracranial artery of patients with acute cerebral infarction by high resolution magnetic resonance imaging,and explore the causes of cerebral infarction. Methods Patients with acute cerebral infarction within 1 week in the Department of Neurology of the Second Affiliated Hospital of Xi'an Jiao tong University from June2017 to June 2018 were collected consecutively. And the data of age,gender,blood glucose,blood lipid,blood pressure,smoking history and homocysteine were collected. According to the HR MRI scanning results,the patients were divided into positive plaque group and negative plaque group,and the clinical data of the two groups were compared. In the negative plaque group vascular abnormality was analyzed by HR MRI. According to the offending vessels,the positive plaque group was divided into the anterior circulation group and the posterior circulation group,and the characteristics of plaque distribution,arterial remodeling index and percentage of arterial wall volume in the two groups were compared. Results A total of52 patients with acute cerebral infarction were enrolled into the study,of which 34 patients were identified as positive plaque and 18 patients as negative plaques by HR MRI. Among the 18 patients,9 cases were identified as cerebral artery dissection( CAD),2 cases as Moyamoya disease( MMD),one case as vasculitis and 6 cases of normal vessels. In the positive plaque group,11( 11/34) cases were normal by magnetic resonance angiography. There were statistically significant differences in hypertension( P = 0. 02) and age( P = 0. 02) between the plaque positive group and the plaque negative group. There were12 patients in the anterior circulation group and 22 patients in the posterior circulation group. The plaque distribution( P =0. 68),the percentage of arterial wall volume( P = 0. 18),and the arterial remodeling index( P = 0. 41) between the anterior circulation group and the posterior circulation group showed no significant difference. Conclusion About assessment of intracranial artery in patients with acute cerebral infarction,HR MRI was superior than the conventional angiography. HR MRI could visualize the arterial wall and provide basis for the rare causes of acute cerebral infarction,such as cerebral artery dissection,vasculitis and Moyamoya disease. There was no significant difference between the anterior circulation group and the posterior circulation group about the plaque distribution,the percentage of arterial wall volume and the arterial remodeling index.
Objective To evaluate the intracranial artery of patients with acute cerebral infarction by high resolution magnetic resonance imaging,and explore the causes of cerebral infarction. Methods Patients with acute cerebral infarction within 1 week in the Department of Neurology of the Second Affiliated Hospital of Xi'an Jiao tong University from June2017 to June 2018 were collected consecutively. And the data of age,gender,blood glucose,blood lipid,blood pressure,smoking history and homocysteine were collected. According to the HR MRI scanning results,the patients were divided into positive plaque group and negative plaque group,and the clinical data of the two groups were compared. In the negative plaque group vascular abnormality was analyzed by HR MRI. According to the offending vessels,the positive plaque group was divided into the anterior circulation group and the posterior circulation group,and the characteristics of plaque distribution,arterial remodeling index and percentage of arterial wall volume in the two groups were compared. Results A total of52 patients with acute cerebral infarction were enrolled into the study,of which 34 patients were identified as positive plaque and 18 patients as negative plaques by HR MRI. Among the 18 patients,9 cases were identified as cerebral artery dissection( CAD),2 cases as Moyamoya disease( MMD),one case as vasculitis and 6 cases of normal vessels. In the positive plaque group,11( 11/34) cases were normal by magnetic resonance angiography. There were statistically significant differences in hypertension( P = 0. 02) and age( P = 0. 02) between the plaque positive group and the plaque negative group. There were12 patients in the anterior circulation group and 22 patients in the posterior circulation group. The plaque distribution( P =0. 68),the percentage of arterial wall volume( P = 0. 18),and the arterial remodeling index( P = 0. 41) between the anterior circulation group and the posterior circulation group showed no significant difference. Conclusion About assessment of intracranial artery in patients with acute cerebral infarction,HR MRI was superior than the conventional angiography. HR MRI could visualize the arterial wall and provide basis for the rare causes of acute cerebral infarction,such as cerebral artery dissection,vasculitis and Moyamoya disease. There was no significant difference between the anterior circulation group and the posterior circulation group about the plaque distribution,the percentage of arterial wall volume and the arterial remodeling index.
引文
[1]李文君,刘俊艳.不同机制症状性颅内动脉粥样硬化性疾病的高分辨率磁共振特征[J].中国卒中杂志,2016,11(4):262-268.
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[11]Derdeyn CP.Moyamoya disease and moyamoya syndrome[J].New England Journal of Medicine,2009,361(1):97-98.
[12]Takagi Y,Kikuta K,Nozaki K,et al.Histological features of middle cerebral arteries from patients treated for Moyamoya disease[J].Neurologia Medico-Chirurgica,2007,47(1):1-4.
[13]Kim JM,Jung KH,Sohn CH,et al.High-resolution MR technique can distinguish moyamoya disease from atherosclerotic occlusion[J].Neurology,2013,80(8):775-776.
[14]Ryoo S,Cha J,Bang OY.Response to letter regarding article,“highresolution magnetic resonance wall imaging findings of Moyamoya disease”[J].Stroke,2014,45(8):2457-2460.
[15]Calabrese LH,Furlan AJ,Gragg LA,et al.Primary angiitis of the central nervous system:diagnostic criteria and clinical approach[J].Cleve Clin J Med,1992,59(3):293.
[16]Ohno K,Saito Y,Kurata H,et al.Vessel wall enhancement in the diagnosis and management of primary angiitis of the central nervous system in children[J].Brain&Development,2016,38(7):694-698.
[17]Kim YS,Lim SH,Oh KW,et al.The advantage of high-resolution MRI in evaluating basilar plaques:a comparison study with MRA[J].Atherosclerosis,2012,224(2):411-416.
[18]Kwee RM,Van Oostenbrugge RJ,Hofstra L,et al.Identifying vulnerable carotid plaques by noninvasive imaging[J].Neurology,2008,70:2401-2409.
[2]Xu WH,Li ML,Gao S,et al.In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis[J].Atherosclerosis,2010,212(2):507-511.
[3]Glagov S,Weisenberg E,Zarins CK,et al.Compensatory enlargement of human atherosclerotic coronary arteries[J].N Engl J Med,1987,316(22):1371-1375.
[4]Ma N,Jiang WJ,Lou X,et al.Arterial remodeling of advanced basilar atherosclerosis:a 3-tesla MRI study[J].Neurology,2010,75(3):253-258.
[5]Klein IF,Lavalle PC,Touboul PJ,et al.In vivo middle cerebral artery plaque imaging by high-resolution MRI[J].Neurology,2006,67(2):327-329.
[6]Qiao Y,Anwar Z,Intrapiromkul J,et al.Patterns and implications of intracranial arterial remodeling in stroke patients[J].Stroke,2016,47(2):434.
[7]Niu PP,Yu Y,Zhou HW,et al.Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging[J].Sci Rep,2016,6:38534.
[8]Schievink WI.Spontaneous dissection of the carotid and vertebral arteries[J].New England Journal of Medicine,2001,345(6):898-906.
[9]Schwartz NE,Vertinsky AT,Hirsch KG,et al.Clinical and radiographic natural history of cervical artery dissections[J].Journal of Stroke&Cerebrovascular Diseases,2009,18(6):416-423.
[10]Baumgartner RW,Arnold M,Baumgartner I,et al.Carotid dissection with and without ischemic events:local symptoms and cerebral artery findings[J].Neurology,2001,57(5):827-832.
[11]Derdeyn CP.Moyamoya disease and moyamoya syndrome[J].New England Journal of Medicine,2009,361(1):97-98.
[12]Takagi Y,Kikuta K,Nozaki K,et al.Histological features of middle cerebral arteries from patients treated for Moyamoya disease[J].Neurologia Medico-Chirurgica,2007,47(1):1-4.
[13]Kim JM,Jung KH,Sohn CH,et al.High-resolution MR technique can distinguish moyamoya disease from atherosclerotic occlusion[J].Neurology,2013,80(8):775-776.
[14]Ryoo S,Cha J,Bang OY.Response to letter regarding article,“highresolution magnetic resonance wall imaging findings of Moyamoya disease”[J].Stroke,2014,45(8):2457-2460.
[15]Calabrese LH,Furlan AJ,Gragg LA,et al.Primary angiitis of the central nervous system:diagnostic criteria and clinical approach[J].Cleve Clin J Med,1992,59(3):293.
[16]Ohno K,Saito Y,Kurata H,et al.Vessel wall enhancement in the diagnosis and management of primary angiitis of the central nervous system in children[J].Brain&Development,2016,38(7):694-698.
[17]Kim YS,Lim SH,Oh KW,et al.The advantage of high-resolution MRI in evaluating basilar plaques:a comparison study with MRA[J].Atherosclerosis,2012,224(2):411-416.
[18]Kwee RM,Van Oostenbrugge RJ,Hofstra L,et al.Identifying vulnerable carotid plaques by noninvasive imaging[J].Neurology,2008,70:2401-2409.
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