颈内动脉系统血管狭窄与脑梗塞模式的影像学研究

发布时间：2018-02-26 02:01

  本文关键词： 颈内动脉 动脉粥样硬化 脑梗塞 梗塞模式 发病机制 弥散加权成像　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过运用MRI弥散加权成像序列(diffusion weighted imaging,DWI)、MR血管成像(magnetic resonance angiography,MRA)、CT血管成像(computed tomo-graphy angiography,CTA)等影像学方法,分析颈内动脉系统动脉粥样硬化重度狭窄或闭塞的急性脑梗塞患者梗塞灶分布模式,探索各血管重度狭窄或闭塞所致脑梗塞的主要发病机制,从而指导临床对脑梗塞患者制定早期治疗及预防复发的策略,以及对颈内动脉系统动脉粥样硬化性狭窄的患者提前给予干预治疗,预防脑梗塞的发生。对象与方法:收集2015-2016年天津医科大学总医院116例急性脑梗塞患者,满足以下标准:1、发病一周内行DWI序列扫描,可见急性脑梗塞灶;2、急性梗塞灶位于单侧颈内动脉系统供血区;3、梗塞灶是同侧大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、颈内动脉颅内段(intracranial internal carotid artery,IICA)或颈内动脉颅外段(extracranial internal carotid artery,EICA)血管动脉粥样硬化重度狭窄(狭窄程度≥70%)或闭塞引起;4、排除其他导致脑梗塞的病因。按照血管狭窄或闭塞的部位将116例患者分为四组:ACA病变组、MCA病变组、IICA病变组、EICA病变组。使用被公认的大脑动脉供血区模板识别梗塞灶的分布,将颅脑血管供血区域划分为穿支动脉供血区、皮质支血管供血区和分水岭区。按照颈内动脉系统供血区梗塞病灶在DWI上的分布,将DWI梗塞模式细分为:1、单一模式:(1)穿支动脉供血区梗塞(perforating artery infarct,PAI);(2)皮质支供血区梗塞(pial artery infarct,PI);(3)分水岭区梗塞(border-zone infarct,BZI);(4)大面积区域性梗塞(large territorial infarct);2、混合模式:(5)PI+PAI;(6)PI+BZI;(7)PAI+BZI;(8)PI+PAI+BZI。结果:1、ACA病变组患者15例,男11例,女4例。ACA重度狭窄或闭塞部位最常见于A2段(80%)。DWI梗塞模式以单一模式(73.3%)多见。所有DWI梗塞模式中,以大面积区域性梗塞(40%)最多见。2、MCA病变组患者60例,男38例,女22例。MCA重度狭窄或闭塞部位最常见于M1段(95%)。DWI梗塞模式以混合模式(63.3%)多见。所有DWI梗塞模式中,以PI+BZI模式(35%)最多见。3、IICA病变组患者18例,男14例,女4例。IICA重度狭窄或闭塞部位最常见于海绵窦段(66.7%)。DWI梗塞模式中,单一模式与混合模式均为9例(50%)。所有梗塞模式中,BZI单一模式7例(38.9%),PI和/或PAI模式2例(11.1%),BZ合并PI和/或PAI模式共存9例(50%)。4、EICA病变组患者23例,男18例,女5例。EICA重度狭窄或闭塞部位最常见于颈动脉窦处21例(91.3%)。DWI梗塞模式以混合模式(60.9%)多见。所有模式中,BZI模式6例(26.1%),PI和/或PAI模式4例(17.4%),BZI合并PI和/或PAI模式13例(56.5%)。结论:ACA粥样硬化性重度狭窄或闭塞最常见的梗塞模式为大面积区域性梗塞,原位血栓栓塞为最主要的发病机制。MCA粥样硬化性重度狭窄或闭塞最常见的梗塞模式为PI+BZI,动脉-动脉栓塞合并血液动力学所致低灌注为最主要的发病机制。IICA与EICA粥样硬化性重度狭窄或闭塞最常见的梗塞模式均为BZI与PI和/或PAI共存的梗塞模式,动脉-动脉栓塞合并血液动力学所致低灌注为最主要的发病机制。
[Abstract]:Objective: through the use of MRI diffusion weighted imaging sequence (diffusion weighted imaging, DWI), MR angiography (magnetic resonance angiography, MRA), CT angiography (computed Tomo-graphy angiography, CTA) and other imaging methods, analysis of severe stenosis or occlusion of coronary atherosclerosis in patients with acute cerebral infarction infarction of internal carotid artery system dynamic distribution pattern and to explore the main pathogenesis of cerebral infarction with severe stenosis or occlusion of the blood vessels, so as to guide the clinical in patients with cerebral infarction for early treatment and relapse prevention strategies, and for patients with atherosclerotic stenosis of internal carotid artery system early intervention, prevention of cerebral infarction. Subjects and methods: collected 116 cases of acute 2015-2016 years in General Hospital Affiliated to Tianjin Medical University in patients with cerebral infarction, to meet the following criteria: 1, the incidence of DWI within one week of sequence scan, seen with acute cerebral infarct; 2, acute Infarct foci in unilateral internal carotid artery system; 3, the infarct is the ipsilateral anterior cerebral artery (anterior cerebral, artery, ACA), middle cerebral artery (middle cerebral, artery, MCA), intracranial segment of internal carotid artery (intracranial internal carotid artery, IICA) or extracranial internal carotid artery (extracranial internal carotid artery. EICA) atherosclerosis stenosis (more than 70% stenosis or occlusion caused; 4), exclusion of other causes of cerebral infarction. According to the location of vascular stenosis or occlusion 116 cases were divided into four groups: ACA lesion group, MCA lesion group, IICA lesion group, EICA lesion group. Brain artery pattern recognition the infarcts distribution using a recognized, the brain blood supply area into perforator artery area, cortical vessel supply area and watershed area. According to the system of internal carotid artery supply area infarction lesions on DWI 鍒嗗竷,灏咲WI姊楀�炴ā寮忕粏鍒嗕福�

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