缺血性脑卒中或TIA患者颅内斑块的3D高分辨率MRI研究

发布时间：2018-03-20 20:12

本文选题：脑梗死　切入点：动脉粥样硬化　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究颅内动脉斑块的强化以及其周围管壁重构模式是否与新近脑缺血性事件的发生存在关联,进而探索颅内动脉粥样硬化疾病(Intracranial Atherosclerotic Disease,ICAD)患者颅内不稳定斑块的影像学指标,从而指导临床对ICAD患者颅内动脉斑块进行精确评估,对其颅内不稳定斑块给予预防性的干预治疗,从而降低脑梗死的发生率。对象与方法:纳入天津医科大学总医院颅内动脉粥样硬化型急性脑缺血事件患者29例(急性缺血性脑卒中患者24例,TIA患者5例;其中男25例,年龄范围41-80岁,平均年龄61.7±9.8岁)。具体纳入排除标准如下:1、通过CTA、MRA或者DSA发现颅内大动脉狭窄;2、颅内狭窄动脉脑供血区域内DWI上发现梗塞灶或有TIA临床症状;3、确定患者属于颅内大动脉类型动脉粥样硬化狭窄;4、排除患者脑缺血症状的同侧颅外颈动脉(extracranial internal carotid artery,EICA)狭窄大于50%;5、排除其他非动脉粥样硬化型的脑缺血性卒中。所有纳入本研究29例患者均在症状出现四周之内进行平扫及增强后3D T1WI-SPACE(three dimensional-T1 weighted imaging-sampling perfection with application optimized contrasts using different flip angle evolutions)及三维时间飞跃法(three dimensional time-of-flight,3D TOF)MRA影像学检查。首先依靠平扫及增强3D T1WI-SPACE、3D TOF MRA来定位29例患者所有颅内动脉斑块。然后,根据DWI上梗塞灶位置或者患者TIA缺血性症状,把所有明确的颅内斑块分为责任斑块(脑缺血区域内供血动脉的唯一或最狭窄血管病灶)组和非责任斑块(血管病灶不在脑缺血区域供血动脉内)组;首先所有斑块依据在增强3D TIWI-SPACE序列上表现(0级强化,表示斑块无强化;1级强化,斑块强化程度大于0级但是强化程度明显小于正常强化的垂体柄信号强度;2级强化,斑块强化近似或强于正常强化垂体柄信号强度)被分类并同时计算斑块强化率;其次,依次测量颅内动脉斑块最狭窄处及其参照位置血管的管腔面积(lumen area,LA)、血管外壁面积(outer wall area,OWA)并计算出管壁面积(wall area,WA);斑块负荷就为斑块最狭窄处WA与OWA测量值之比;斑块处管壁重构率(remodelling ratio,RR)为斑块最狭窄处LA与参照位置LA的测量值之比,重构模式分类依据:正性重构RR1.05;中间值,0.95≤RR≤1.05;负性重构RR0.95。结果:1、29例急性脑血管事件患者共计发现81个颅内斑块,其中责任斑块29个,非责任斑块52个。所有29个责任斑块均强化(1级强化38%,2级强化62%);所有52个非责任斑块中,仅21个斑块发现强化(1级强化86%,2级强化14%);经过定性分析所有斑块发现,0级强化斑块只存在非责任斑块组中,2级强化与责任斑块有一定关联。经过定量比较分析,责任斑块的强化率与非责任斑块的强化率存在显著的差异性(P0.001);责任斑块强化率(0.957±0.33)几乎是非责任斑块强化率(0.429±0.30)两倍。2、所有29名患者的责任斑块处管壁重构率(0.97±0.31)与非责任斑块处管壁重构率(1.08±0.29)没有明显差异(P=0.24)。但是责任斑块组患者斑块负荷明显高于非责任斑块组患者(P0.05)。结论:本研究发现ICAD患者斑块显著强化的这一特点可以用来发现缺血性脑血管事件患者的颅内责任血管病灶;这一MR影像特点可能反应斑块炎症和其内大量新生血管并且有可能是颅内不稳定斑块的标志物,并且能够为患者评估颅内斑块表现的是否为高风险斑块,以及将来缺血性脑卒中发生的可能提供的一个比较深入的风险评估,从而可以让患者从预防性干预治疗获益。
[Abstract]:Objective: To explore enhanced intracranial atherosclerotic plaque and the tube wall around the reconstruction patterns and new brain ischemic events are related, and then explore the intracranial atherosclerotic disease (Intracranial Atherosclerotic, Disease, ICAD) index in patients with intracranial atherosclerotic plaque imaging to guide clinical accurate assessment of intracranial arterial ICAD in patients with stable plaque, not on the intracranial intervention preventive patch, so as to reduce the incidence of cerebral infarction. Subjects and methods: in General Hospital Affiliated to Tianjin Medical University of intracranial atherosclerosis acute cerebral ischemic events in patients with 29 cases (24 cases, 5 cases of patients with acute ischemic stroke; TIA patients with 25 males, age range 41-80 years old, the average age of 61.7. At the age of 9.8). The specific inclusion and exclusion criteria are as follows: 1, through CTA, MRA or DSA found large intracranial artery stenosis; 2, intracranial arterial stenosis and cerebral The infarction or clinical symptoms of TIA blood DWI in the region; 3, to identify patients with intracranial large artery atherosclerotic stenosis belongs to type; 4, ipsilateral cranial exclusion of patients with cerebral ischemic symptoms of external carotid artery (extracranial internal carotid artery, EICA) stenosis greater than 50%; 5, the exclusion of other non atherosclerotic ischemic stroke type. All 29 patients were enrolled in the study in symptoms for plain and enhanced 3D (three dimensional-T1 weighted T1WI-SPACE four weeks imaging-sampling perfection with application optimized contrasts using different flip angle evolutions) and three dimensional time of flight (three dimensional time-of-flight, 3D TOF) MRA imaging. The first to rely on the plain and enhanced 3D T1WI-SPACE. 3D TOF MRA to locate the 29 patients of intracranial atherosclerotic plaque. Then, according to the DWI on the infarct location or patient TIA ischemic symptoms, all clear intracranial lesions were divided into plaque responsibility (cerebral ischemia area of feeding arteries or narrow vascular lesions) and non plaque group (not the responsibility vascular lesions in cerebral ischemic area in the feeding artery group); first of all according to plaque on enhanced 3D TIWI-SPACE sequence showed enhancement (grade 0 No, said the plaque strengthening; 1 level enhancement, the pituitary stalk signal strength; the degree of plaque enhancement is greater than 0 but the enhancement degree was significantly lower than that of normal reinforced 2 enhanced plaque enhancement in the normal approximation or strengthen the pituitary stalk signal strength) are classified and calculated the plaque enhancement rate; secondly, in order to measure intracranial artery stenosis plaque lumen area and position reference vessels (lumen area, LA), the vascular wall area (outer wall, area, OWA) and the calculated wall area (wall, area, WA); plaque burden for plaque at the most narrow WA and OWA Measurements of the ratio; wall reconstruction rate plaques (remodelling ratio, RR) to measure the plaque at the most narrow LA and the reference position of LA value ratio, reconstruction pattern classification based on: positive remodeling of RR1.05; the middle value of RR = 0.95 ~ 1.05; negative remodeling of RR0.95. results: 1,29 patients with acute cerebrovascular events patients found a total of 81 intracranial plaque, the plaque responsibility 29, non responsibility plaque 52. All 29 plaques were enhanced (1 level responsibility to strengthen the 38%, 2 grade 62%; strengthen the) all 52 non responsibility plaques, 21 plaques found only strengthened (Level 1 Level 2 to strengthen the 86%, strengthen 14%) after the qualitative analysis; all plaques, 0 plaques exist only to strengthen non responsibility plaque group, 2 strengthen and responsibility plaque has a certain relevance. Through quantitative analysis, strengthen the responsibility and liability rate of plaque plaque enhancement rate there was a significant difference (P0.001); responsibility (0.957 + 0.33 plaque enhancement rate a few) It is not the responsibility of plaque enhancement rate (0.429 + 0.30).2 two times, the wall reconstruction rate of liability plaques in all 29 patients (0.97 + 0.31) wall reconstruction rate and non responsibility plaque tube (1.08 + 0.29) there was no significant difference (P=0.24). But the responsibility of plaque group was significantly higher in patients with plaque load the responsibility of non plaque group patients (P0.05). Conclusion: This study found that the characteristics of plaque in patients with ICAD significantly enhanced intracranial vascular lesions can be used to find out the responsibility of ischemic cerebrovascular events in patients; the MR imaging features of plaque inflammation and its possible reaction within a large number of new vessels and may serve as a marker for intracranial atherosclerotic plaque. And for patients to assess intracranial plaque performance is a high risk of plaque and the occurrence of ischemic stroke in the future may provide a more in-depth risk assessment, which can make patients benefit from prophylactic pretreatment.

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

【参考文献】