3.0T高分辨率磁共振成像对大脑中动脉粥样硬化斑块与脑梗死关系的研究

发布时间：2018-05-03 17:28

本文选题：高分辨率磁共振 + 大脑中动脉　；参考：《南京医科大学》2017年硕士论文

【摘要】：目的:使用高分辨率磁共振(high-resolution magnetic resonance imaging,HRMRI)成像方法,探讨大脑中动脉(middle cerebral artery,MCA)粥样硬化斑块的分布特征,并进一步分析斑块分布与急性脑梗死的关系。方法:收集2015年8月-2016年4月南京市第一医院神经内科33例有临床症状的MCA粥样硬化狭窄的病人,先进行常规头颅磁共振扫描,MRA发现有单侧MCA主干狭窄时,再垂直于MCA狭窄处进行黑血技术T1加权成像(Tl-weightedimaging,T1WI)、T2 加权成像(T2-weighted imaging,T2WI)扫描。将动脉粥样硬化斑块的分布位置分为前壁、下壁、后壁、上壁;依据弥散加权图像上MCA供血区有无高信号,将研究对象分为急性脑梗死、无急性脑梗死。统计斑块各分布部位例数及其相应的急性脑梗死的例数。结果:33例图像纳入研究,斑块的分布情况为前壁14例、下壁7例、上壁4例、后壁4例,余4例为管腔完全闭塞,各分布部位的相应急性脑梗死例数为2、2、4、3,4例闭塞者均有急性脑梗死;位于上壁或后壁的斑块较位于前壁或下壁斑块更易引起急性脑梗死,差异有统计学意义(P=0.001)。结论:大脑中动脉粥样硬化狭窄处的斑块好发于血管的前壁和下壁,但位于上壁或后壁粥样硬化斑块更易引发急性脑梗死。目的:近年来,HRMRI被用于显示颅内动脉血管壁的结构特点,本文使用HRMRI成像方法,分析动脉粥样硬化性MCA狭窄处血管壁的重构方式及其与急性脑梗死之间的关系。方法:收集2015年8月至2016年4月我院神经内科33例有头晕、言语不清、肢体无力、意识不清等症状的病人,常规头颅磁共振检查时MRA发现单侧粥样硬化性MCA主干狭窄的,则垂直于狭窄处进行黑血技术T1WI、T2WI、PDWI血管壁扫描。计算最狭窄处的血管面积、管腔面积、管壁面积、斑块面积、重构指数以及记录病人入院时的NIHSS(NationalInstitute of Health stroke scale,美国国立卫生研究院卒中量表)评分,比较急性脑梗组与无急性脑梗组之间、正性重构组与非正性重构组之间的血管壁各测量参数及NIHSS分数的差异。结果:33例图像用于分析,其中,急性脑梗组有15例,无急性脑梗组有18例;正性重构组有14例,非正性重构组有19例。在MCA最狭窄处,急性脑梗组的较无急性脑梗组有更大的重构指数[(1.07±0.09)比(0.94±0.08),P0.001]、斑块面积[(4.76±2.00)mm2比(2.33±1.32)mm2,P0.001]、管壁面积[(13.84±3.05)mm2比(11.79±2.44)mm2,P=0.04]、NIHSS分值[(4.87±2.88)比(1.44±3.07),P=0.003]。急性脑梗组中正性重构较多(12例),无急性脑梗组中负性重构较多(11例),差异有统计学意义(P=0.002)。与非正性重构组相比,正性重构组有更大的斑块面积[(4.42±2.05)mmm2比(2.70±1.75)mm2,P=0.014]、NIHSS分值[(4.43±3.37)比(1.95±3.12),P=0.037]。正性重构组有12例MCA供血区出现急性脑梗死,非正性重构组有3例,差异有统计学意义(P0.001)。结论:急性脑梗组在MCA粥样硬化性狭窄处以正性重构方式为主,较无急性脑梗组有更大的斑块负荷、重构指数。正性重构较非正性重构更易引起脑梗死,是一种不稳定的重构方式。目的使用HRMRI成像方法,评估大脑中动脉粥样硬化斑块的强化程度与脑梗死之间的关系。方法收集2015年8月至2016年4月33例我院神经内科有脑缺血症状且MRA显示单侧MCA主干狭窄的病人,行常规头颅MR检查后,再垂直于血管狭窄处进行黑血序列T1WI、T2WI、增强T1WI扫描。根据弥散加权成像上狭窄侧MCA供血区有无高信号,将病人分为急性脑梗组、无急性脑梗组。将增强后斑块的强化程度分为明显强化、轻度强化、无强化,比较两组间粥样硬化斑块的三种强化方式例数的差异。结果33例图像纳入研究,急性脑梗组有15例,无急性脑梗组有18例。急性脑梗组有11例明显强化、1例轻度强化、3例无强化;无急性脑梗组有1例明显强化、4例轻度强化、13例无强化。急性脑梗组的明显强化斑块多于无急性脑梗组(P=0.000);无强化斑块少于无急性脑梗组(P=0.005),差异具有统计学意义。结论 HRMRI增强扫描可以观察MCA粥样硬化斑块的强化程度;斑块的明显强化更多见于急性脑梗组,提示其不稳定性,可预测脑卒中的风险。
[Abstract]:Objective: To explore the distribution characteristics of the atherosclerotic plaque of the middle cerebral artery (middle cerebral artery, MCA), and to further analyze the relationship between the plaque distribution and the acute cerebral infarction by using the high-resolution magnetic resonance imaging (HRMRI) imaging method. Methods: to collect the God of the first hospital of Nanjing in August 2015 and April. 33 cases of MCA atherosclerotic stenosis with clinical symptoms were scanned with conventional cranial magnetic resonance (MRI), and MRA was found to have T1 weighted imaging (Tl-weightedimaging, T1WI), T2 weighted imaging (T2-weighted imaging, T2WI) scan at MCA stenosis at MCA stenosis. The atherosclerotic plaque was observed. The distribution position was divided into the anterior wall, the lower wall, the posterior wall and the upper wall. According to the MCA blood supply area on the diffusion-weighted image, there were no high signals, and the subjects were divided into acute cerebral infarction, no acute cerebral infarction. The number of distribution parts of plaque and the number of corresponding acute cerebral infarction were counted. Results: 33 cases were included in the study, and the distribution of plaque was 14 cases of anterior wall. There were 7 cases in the lower wall, 4 cases in the upper wall, 4 cases in the posterior wall and 4 cases of complete occlusion of the lumen. The number of corresponding acute cerebral infarction in each distribution area had acute cerebral infarction in 2,2,4,3,4 cases. The plaques located at the upper wall or the posterior wall were more susceptible to acute cerebral infarction than the anterior or lower wall plaques. The difference was statistically significant (P=0.001). Conclusion: middle cerebral artery (middle cerebral artery). Atherosclerotic plaque at the atherosclerotic stenosis occurs well in the anterior and lower walls of the vessel, but the atherosclerotic plaque at the upper wall or the posterior wall is more likely to cause acute cerebral infarction. Objective: in recent years, HRMRI has been used to display the structural characteristics of the vascular wall of the intracranial arteries. In this paper, the reconstruction of the vascular wall at the atherosclerotic MCA stenosis was analyzed by HRMRI imaging. Formula and its relationship with acute cerebral infarction. Methods: from August 2015 to April 2016, 33 patients with symptoms such as dizziness, poor speech, weak limbs and unconsciousness were collected from the Department of Neurology of our hospital from August 2015 to April 2016. At the time of routine head magnetic resonance examination, MRA found that the unilateral atherosclerotic MCA trunk was narrow and narrow, then the black blood technique T1WI, T2WI was carried out vertically to the stenosis. PDWI vascular wall scan. Calculate the vascular area, lumen area, wall area, patch area, remodeling index, and NIHSS (NationalInstitute of Health stroke scale, National Institutes of Health Stroke Scale) score at the admission of patients, compared with the acute cerebral infarction group and the non acute cerebral infarction group. Results of 33 cases of acute cerebral infarction, there were 15 cases of acute cerebral infarction, 18 cases without acute cerebral infarction, 14 in the positive reconfiguration group and 19 in the non positive reconstruction group. In the narrowest MCA, the acute cerebral infarction group had a larger reconstruction index than that in the non acute cerebral infarction group (1). 7 + 0.09) ratio (0.94 + 0.08), patch area [(4.76 + 2) mm2 ratio (2.33 + 1.32) mm2, P0.001], tube wall area [(13.84 + 3.05) mm2 ratio (11.79 + 2.44)), P=0.04], NIHSS score [(4.87 +]), more positive reconstruction in P=0.003]. acute cerebral infarction group. There was no statistical difference in acute cerebral infarction group (cases), the difference was statistically significant Learning significance (P=0.002). Compared with the non positive reconstruction group, the positive reconstruction group had larger patch area [(4.42 + 2.05) mmm2 ratio (2.70 + 1.75) mm2, P=0.014], NIHSS score [(4.43 + 3.37) ratio (1.95 + 3.12)). There were 12 patients with MCA in the P=0.037]. positive reconstruction group with acute cerebral infarction and 3 cases in the non positive reconstruction group, the difference was statistically significant (P0.001). In the acute cerebral infarction group, there is a positive reconstruction in MCA atherosclerotic stenosis, which is more likely to cause cerebral infarction than the non positive reconstruction. The objective of HRMRI imaging is to evaluate the strength of the atherosclerotic plaque in the brain. Methods the relationship between the degree of cerebral infarction and cerebral infarction was collected. Methods 33 patients with cerebral ischemia in our hospital from August 2015 to April 2016 were collected and MRA showed unilateral MCA trunk stenosis. After routine head MR examination, T1WI, T2WI, and enhanced T1WI scan were performed vertically to the stenosis of blood vessels. MCA in the narrow side of the stenosis weighted imaging MCA. There were no high signals in the blood supply area. The patients were divided into acute cerebral infarction group and no acute cerebral infarction group. The enhancement degree of the enhanced plaque was divided into obvious strengthening, mild strengthening and no enhancement. The difference of the number of three intensification methods of atherosclerotic plaque between the two groups was compared. The results of 33 cases were included in the study, the acute cerebral infarction group had 15 cases, and the non acute cerebral infarction group had 18. In acute cerebral infarction group, there were 11 cases of obvious enhancement, 1 cases of mild strengthening, 3 cases without enhancement, 1 cases in the acute cerebral infarction group, 4 cases of mild strengthening and 13 cases without enhancement. The obvious enhanced plaque in the acute cerebral infarction group was more than that in the non acute cerebral infarction group (P=0.000), and the non intensification plaque was less than the non acute cerebral infarction group (P=0.005), the difference was statistically significant. Conclusion HRMR I enhanced scan can observe the intensification of MCA atherosclerotic plaque, and the obvious enhancement of plaque is more seen in the acute cerebral infarction group, indicating its instability and predicting the risk of cerebral apoplexy.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R445.2

【参考文献】