目的:通过计算机断层摄影动脉造影术(computed tomography arteriography, CTA)和高分辨磁共振成像(high resolution-magnetic resonance imaging, HR-MRI)两种影像检查方法评价引起缺血性脑卒中的责任血管,探讨脑梗死的发生发展与血管狭窄程度、责任斑块内出血、责任斑块的强化程度的关联性。方法:选取2018年08月至2020年12月接受常规颅脑MRI影像学检查,且影像诊断为单侧大脑中动脉(MCA)供血区急性脑梗死的患者为研究对象,分别采用CTA(CTA检查组)和HR-MRI(HR-MRI检查组)分析患者MCA粥样斑块所致管腔狭窄程度及可能的斑块组分,20例/组,其中HR-MRI组包含10例HR-MRI平扫患者和10例HR-MRI增强患者,在图像后处理工作站勾画梗死灶并测量最大层面面积,由2位副高以上诊断医师对责任血管管腔的狭窄程度、斑块成分以及斑块强化程度进行分析,采用Pearson线性相关和Spearman等级相关法评价血管狭窄程度与梗死灶面积之间的关联性,采用卡方检验分析比较不同斑块成分和不同斑块强化程度患者的梗死灶面积。结果:CTA检查组和HR-MRI检查组的责任血管狭窄程度均与梗死灶面积无相关性(P＞0.05);在HR-MRI平扫组中,斑块表现为T1WI高或稍高信号,T2WI混杂信号者的梗死灶面积高于表现为其他信号者(P＜0.05);在HR-MRI增强检查组,斑块高强化者的梗死灶面积大于中度强化者的梗死灶面积(P＜0.05)。结论:相对于责任血管的狭窄程度,颅内动脉斑块内出血及炎症反应是决定脑梗死转归更为重要的因素。
Objective:To evaluate the responsible vessels for ischemic stroke with computed tomography arteriography (CTA) and high resolution-magnetic resonance imaging (HR-MRI) , and to explore the relationship between the occurrence and development of cerebral infarction and the degree of vascular stenosis, the composition and stability of the responsible plaque. Methods: Patients who underwent routine brain MRI examination from August 2018 to December 2020 in our hospital and diagnosed with acute cerebral infarction of unilateral middle cerebral artery (MCA) territory were included in the study. CTA and HR-MRI were used to analyze the degree of lumen stenosis caused by MCA atheromatous plaque and possible plaque components, 20 cases in each group (CTA group and HR-MRI group) and the HR-MRI group included 10 patients with HR-MRI plain scan (HR-MRI plain scan group, n=10) and 10 patients with contrast-enhanced HR-MRI (HR-MRI contrast-enhanced group, n=10). The image post-processing workstation was used to outline the infarction and measure the maximum sectional area, and two experienced diagnosticians analyzed the stenosis degree, plaque composition, and plaque enhancement degree of the responsible vessels. Pearson's linear correlation and Spearman's rank correlation were used to evaluate the relationship between the degree of vascular stenosis and infarct size. Chi-square analysis was used to compare the infarct size of patients with different plaque components and different plaque enhancement degrees. Results: There was no correlation between the degree of responsible vessel stenosis and the infarct size in either the CTA group or the HR-MRI group (P＞0.05). In the HR-MRI plain scan group, the plaques showed high or slightly high signal of T1WI, and the infarct size of those with the mixed signal of T2WI was significantly higher than that of those with other signals (P＜0.05). In the HR-MRI contrast-enhanced group, the infarct area of the patients with high plaque enhancement was significantly larger than that of the patients with moderate enhancement (P＜0.05). Conclusion: Compared with the stenosis degree of the responsible vessel, intracranial arterial plaque hemorrhage and inflammatory response are more important prognostic factors for cerebral infarction.
[1] Zhang DF, Chen YC, Chen HY, et al. A high-resolution MRI study of relationship between remodeling patterns and ischemic stroke in patients with atherosclerotic middle cerebral artery stenosis[J]. Front Aging Neurosci, 2017, 9:140.
[2] 张权, 韩广明, 乔建勇, 等. 彩色多普勒超声、CTA、DSA诊断颈动脉狭窄的准确性对比分析[J]. 世界最新医学信息文摘, 2019, 19(16):1-2.
[3] 沈华. 头颈联合CT血管造影在头颈动脉狭窄中的应用[J]. 临床医药文献电子杂志, 2019, 6(1):153.
[4] Sadat U, Teng ZZ, Young VE, et al. Three-dimensional volumetric analysis of atherosclerotic plaques:a magnetic resonance imaging-based study of patients with moderate stenosis carotid artery disease[J]. Int J Cardiovasc Imaging, 2010, 26(8):897-904.
[5] 肖嘉昱, 蒋涛, 杨旗, 等. 短暂性脑缺血发作患者颅内动脉斑块特征的高分辨率磁共振研究[J]. 中国医学影像学杂志, 2019, 27(8):578-583.
[6] Yang WJ, Wong KS, Chen XY. Intracranial atherosclerosis:from microscopy to high-resolution magnetic resonance imaging[J]. J Stroke, 2017, 19(3):249-260.
[7] 刘聪, 宋焱. 磁共振血管壁成像对颅内动脉粥样硬化斑块易损性及疗效评估的研究进展[J]. 磁共振成像, 2022, 13(3):118-121.
[8] 王红茹, 高阳, 吴琼. 高分辨率磁共振血管壁成像在颅内动脉粥样硬化斑块上的研究进展[J]. 磁共振成像, 2021, 12(9):95-97, 102.
[9] 王洁, 陈峰, 董海波, 等. 功能磁共振对颈动脉狭窄患者支架植入术前后脑功能改变的评估作用[J]. 中国现代医生, 2018, 56(6):107-111.
[10] 韦程纲, 谭洁莹, 徐向东, 等. 磁共振高分辨扫描在基底动脉斑块中的应用[J]. 广东医学, 2018, 39(4):544-547.
[11] 肖晓怡, 曾献军. 高分辨磁共振成像在颅内动脉夹层的应用进展[J]. 江西医药, 2018, 53(2):179-182.
[12] Turan TN, Rumboldt Z, Granholm AC, et al. Intracranial atherosclerosis:correlation between in-vivo 3T high resolution MRI and pathology[J]. Atherosclerosis, 2014, 237(2):460-463.
[13] Portanova A, Hakakian N, Mikulis DJ, et al. Intracranial vasa vasorum:insights and implications for imaging[J]. Radiology, 2013, 267(3):667-679.
[14] Chen XY, Wong KS, Lam WWM, et al. Middle cerebral artery atherosclerosis:histological comparison between plaques associated with and not associated with infarct in a postmortem study[J]. Cerebrovasc Dis, 2008, 25(1-2):74-80.
[15] Mazighi M, Labreuche J, Gongora-Rivera F, et al. Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke[J]. Stroke, 2008, 39(4):1142-1147.
[16] Labadzhyan A, Csiba L, Narula N, et al. Histopathologic evaluation of basilar artery atherosclerosis[J]. J Neurol Sci, 2011, 307(1-2):97-99.
[17] Ibrahim T, Makowski MR, Jankauskas A, et al. Serial contrast-enhanced cardiac magnetic resonance imaging demonstrates regression of hyperenhancement within the coronary artery wall in patients after acute myocardial infarction[J]. JACC Cardiovasc Imaging, 2009, 2(5):580-588.
[18] Qiao Y, Zeiler SR, Mirbagheri S, et al. Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images[J]. Radiology, 2014, 271(2):534-542.
[19] Lau AY, Zhao YD, Chen C, et al. Dual antiplatelets reduce microembolic signals in patients with transient ischemic attack and minor stroke:subgroup analysis of CLAIR study[J]. Int J Stroke, 2014, 9(Suppl A100):127-132.
