粥样硬化性大脑中动脉狭窄的高分辨率磁共振成像及对脑梗死类型的预测

发布时间：2018-05-17 00:00

本文选题：大脑中动脉 + 动脉粥样硬化　；参考：《东南大学》2016年博士论文

【摘要】：大脑中动脉(middle cerebral artery, MCA)粥样硬化性疾病是中国人发生缺血性脑卒中的主要原因之一。卒中危险的预测因素不仅包括管腔的狭窄程度,而且与粥样斑块的特征密切相关。最近一些研究已证实：高分辨率磁共振(high-resolution magnetic resonance imaging, HR MRI)不仅能评估粥样硬化性MCA狭窄的程度,而且能显示管壁的特征。本研究旨在应用HR MRI分析粥样硬化性MCA狭窄的管壁特征以及与梗死类型的关系,探讨HR MRI在指导卒中危险分级及治疗方案选择的潜在价值。第一部分症状性粥样硬化性大脑中动脉狭窄的高分辨率磁共振成像研究目的利用HR MRI成像,比较分析有症状与无症状性粥样硬化性MCA狭窄的管壁特征。方法 64例中重度粥样硬化性MCA狭窄患者行3.0T HR MRI检查,予MCA黑血技术T1加权成像(T1-weighted imaging, T1WI)、质子密度加权成像(proton density weighted imaging, PDWI)及T2加权成像(T2-weighted imaging, T2WI)的横断面扫描,以及应用可变翻转角的三维快速自旋回波成像技术(three-dimension sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)及其多平面重建,计算血管面积(vessel wall area, VA)、管腔面积(lumen area,LA)、斑块面积(plaque area, PA)及重构指数(remodeling index, RI),分析斑块位置、形态及信号特点,比较症状组与无症状组之间的差别。采用多因素回归分析症状性粥样硬化性MCA狭窄的独立预测因素。结果 7例因图像质量差,排除研究之外。57例图像用于最终分析,35例为症状性狭窄,22例为无症状组。症状组PA及RI明显高于无症状组(PA：5.40±1.85mm2与4.36±1.53 mm2,P=0.046；RI：1.06±0.10与1.00±0.09,P=0.021),且正性重构(positive remodeling, PR)、斑块位于上壁的位置分布及斑块表面不光整在症状组中更多见(P=0.038,P=0.034,P=0.032)。19例斑块表层于T2WI可见完整弧形或斑点状高信号灶,其中6例斑块可见清晰信号分层。斑块表层的T2WI高信号灶于两组中无明显统计学差异。斑块位于上壁的位置分布,可作为症状性粥样硬化性MCA狭窄的独立预测因素(OR=0.226；P=0.037)。结论症状性粥样硬化性MCA狭窄常有大的斑块负荷,且斑块表面不光整、位于上壁的位置分布以及PR重构方式多见。这些特征有望指导粥样硬化性MCA狭窄患者的卒中危险分级。第二部分基于高分辨率磁共振成像对粥样硬化性大脑中动脉重构的分析目的利用HR MRI,探讨中重度粥样硬化性MCA狭窄不同重构模式的管壁特征。方法 64例中重度MCA粥样硬化性狭窄患者行3.OT MR检查,予MCA黑血技术T1WI、PDWI、T2WI及3D-SPACE技术扫描,计算血管面积(VA)、管腔面积(LA)、斑块面积(PA)及重构指数(RI),分析各序列斑块特点,比较正性重构(PR)及非PR组之间的差别。结果 57例图像用于最终分析,28例为PR,29例为非PR。PR组最狭窄处的VA、管壁面积(wall area, WA)及PA较非PR组大(VAMLN：16.18±2.65mm2与14.34±2.99mm2,P=0.003；WAMLN:10.79±2.27mm2与9.00±1.77mmm2,P=0.002；PA：6.11±1.77mm2与3.93±1.OOmm2,P=0),且斑块表面不光整(53.6%与27.6%,P=0.046)及弥散加权成像(diffusion-weighted magnetic resonance imaging, DWI)上的高信号灶(71.4%与34.5%,P=0.005)在PR组更多见。结论有PR重构方式的MCA粥样硬化性狭窄患者,常有大的斑块负荷、斑块表面常不光整,易于发生斑块破裂及继发卒中的风险。第三部分粥样硬化性大脑中动脉狭窄的管壁特征对脑梗死类型的预测目的利用HR MRI,评估粥样硬化性MCA狭窄的管壁特征,并探讨管壁特征与梗死类型的关系。方法 36例有粥样硬化性MCA狭窄的急性缺血性卒中患者行3.OT MR检查,包括头颅弥散加权成像(DWI)及MCA的HR MRI扫描,对斑块表面不光整性、斑块上壁位置分布、斑块内T2WI高信号灶以及正性重构(PR)特点进行分析。根据DWI图像上急性梗死灶的数量(分为单发与多发梗死)及位置分布方式(分为皮层梗死、分水岭梗死与穿支动脉梗死)对梗死进行分型,探讨管壁特征与梗死类型之间的关系。结果 30例患者图像用于最终分析。 20例粥样硬化性MCA狭窄表现为PR重构模式,18例MCA斑块表面不光整,14例患者MCA斑块位于上壁,13例患者MCA斑块于T2WI可见高信号灶。所有急性梗死患者中,17例于DWI表现为多发梗死,13例表现为单发梗死。在多发梗死病例中,分水岭梗死占绝大多数(76.5%)。在所有单发梗死病例中,穿支动脉梗死占76.9%。多发梗死灶常见于有PR重构方式(P=0.007)或斑块表面不光整(P=0.035)的MCA狭窄患者。单发梗死,尤其是穿支动脉梗死,多见于斑块位于上壁的MCA粥样硬化性狭窄的患者(P=0.030)。在所有斑块T2WI高信号灶患者中,单发与多发梗死方式的发生率之间无统计学差异(P=0.638)结论颅内动脉粥样硬化性MCA狭窄的患者,若有PR重构方式或斑块表面不光整的管壁特征,将可能更易发生动脉-动脉的栓塞。斑块位于上壁的MCA粥样硬化性狭窄的患者,将可能多发生穿支动脉梗死。HR MRI能活体直观显示粥样硬化MCA的管壁特征,对可能发生的梗死类型有一定的预测作用。
[Abstract]:The middle cerebral artery (MCA) atherosclerotic disease is one of the main causes of ischemic stroke in China. The predictors of stroke risk not only include the stenosis of the lumen, but also are closely related to the characteristics of atherosclerotic plaques. Recent studies have confirmed that high resolution magnetic resonance (high-resolution magn). Etic resonance imaging, HR MRI) not only can assess the degree of atherosclerotic MCA stenosis, but also show the characteristics of the tube wall. This study aims to apply HR MRI to analyze the characteristics of the tube wall of atherosclerotic MCA stenosis and the relationship with the type of infarction, and to explore the potential value of HR MRI in guiding the risk classification of stroke and the choice of treatment options. High resolution magnetic resonance imaging (MRI) of symptomatic atherosclerotic middle cerebral artery stenosis (HR MRI imaging), the characteristics of symptomatic and asymptomatic atherosclerotic MCA stenosis were compared and analyzed. Methods 64 patients with moderate and severe atherosclerotic MCA stenosis were examined by 3.0T HR MRI, and MCA black blood technique was given T1 weighted imaging (T1-weig). Hted imaging, T1WI), proton density weighted imaging (proton density weighted imaging, PDWI) and T2 weighted imaging (T2-weighted imaging, T2WI) cross section scanning, and three-dimensional fast spin echo imaging technique with variable turning angle. Erent flip angle evolutions, 3D-SPACE) and its multiplane reconstruction, calculation of vascular area (vessel wall area, VA), lumen area (lumen area, LA), plaque area and reconstruction index, analysis of plaque position, shape and signal characteristics, compare the difference between symptomatic and asymptomatic groups. Multifactor factors are used. Regression analysis of independent predictors of symptomatic atherosclerotic MCA stenosis. Results 7 cases of.57 images were used for final analysis because of poor image quality, 35 cases were symptomatic and 22 were asymptomatic. The symptoms group PA and RI were significantly higher than those in the asymptomatic group (PA:5.40 + 1.85mm2 and 4.36 + 1.53 mm2, P=0.046; RI:1.06 + 0.10 and 1) 0 + 0.09, P=0.021), and positive reconstruction (positive remodeling, PR), the position distribution of the plaque on the upper wall and the plaque surface not only in the symptom group, more see (P=0.038, P=0.034, P=0.032).19 case on the surface of.19, the surface of the plaque can be seen as a complete arc or speckled high signal focus, of which 6 cases have clear signal stratification. The T2WI high letter of the plaque surface is high. There was no significant difference between the two groups. The location of the plaque located on the upper wall was an independent predictor of symptomatic atherosclerotic MCA stenosis (OR=0.226; P=0.037). Conclusion symptomatic atherosclerotic MCA stenosis often has a large plaque load, and the plaque surface is not smooth, the location of the upper wall and the mode of PR reconstruction. These features are expected to guide the risk classification of stroke in patients with atherosclerotic MCA stenosis. The second part is based on the analysis of the reconstruction of atherosclerotic middle cerebral arteries based on high resolution magnetic resonance imaging (high resolution MRI) purpose using HR MRI to explore the wall characteristics of different remodeling patterns of moderate and severe atherosclerotic MCA stenosis. Methods 64 cases of moderate to severe MCA porridge Patients with sclerosing stenosis were examined by 3.OT MR, and MCA black blood technology T1WI, PDWI, T2WI and 3D-SPACE were scanned. Vascular area (VA), lumen area (LA), patch area (PA) and reconstruction index (RI) were calculated. The characteristics of plaque in each sequence were analyzed, and the difference between positive reconstruction (PR) and non group was compared. The results of 57 cases were analyzed, 28 cases were 2, 2 9 cases were the narrowest VA in the non PR.PR group, the wall area of the tube (wall area, WA) and PA were larger than those in the non PR group (VAMLN:16.18 + 2.65mm2 and 14.34 + 2.99mm2, P=0.003, WAMLN:10.79 + and 9 +. The high signal foci on -weighted magnetic resonance imaging, DWI (71.4% and 34.5%, P=0.005) are more common in the PR group. Conclusion the patients with MCA atherosclerotic stenosis with PR remodeling often have large plaque load, the plaque surface is often not full, and the plaque rupture and the risk of subsequent stroke are prone to occur. Third parts of the atherosclerotic brain are in the middle movement. Prediction of cerebral infarction types by using HR MRI to assess the wall characteristics of atherosclerotic MCA stenosis and to explore the relationship between the canal wall characteristics and infarct types. Methods 36 cases of acute ischemic stroke with atherosclerotic MCA stenosis were examined by 3.OT MR, including cranial diffusion weighted imaging (DWI) and MCA HR MRI. The features of the plaque surface integrity, the location of the upper wall of the plaque, the T2WI high signal focus and the positive reconstruction (PR) in the plaque were analyzed. According to the number of acute infarcts on the DWI images (divided into single and multiple infarcts) and the location distribution (divided into cortical infarcts, watershed infarcts and perforating artery infarction), the infarcts were classified. The relationship between the characteristics of the wall of the tube and the type of infarction was discussed. Results 30 cases of patients were used for final analysis. 20 cases of atherosclerotic MCA stenosis showed PR remodeling pattern, 18 cases of MCA plaque surface was not light, 14 patients were located in the upper wall of MCA plaque, and 13 patients with MCA plaque on T2WI. All of the patients with acute infarction were in the DWI table. Multiple infarcts are seen in 13 cases. Among the cases of multiple infarction, watershed infarction accounts for the vast majority (76.5%). In all cases of single infarction, perforating artery infarction accounts for 76.9%. multiple infarcts in patients with MCA stenosis with PR reconstruction (P=0.007) or plaque surface incomplete (P=0.035). Single infarction, especially perforating branch Arterial infarction, mostly in patients with MCA atherosclerotic stenosis in the upper wall (P=0.030). There is no significant difference in the incidence of single and multiple infarct patterns in all patients with T2WI high signal foci (P=0.638) in patients with intracranial atherosclerotic MCA stenosis, if there is a PR remodeling mode or the plaque surface is not smooth. The characteristics of the tube wall may be more likely to occur in arterial and arterial embolization. The patients with MCA atherosclerotic stenosis at the upper wall may have perforating artery infarction.HR MRI, which can visualized the wall characteristics of the atherosclerotic MCA in vivo, and may have a certain predictive effect on the possible type of infarction.
【学位授予单位】：东南大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743.3;R445.2

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