高分辨率磁共振（HRMRI）应用于缺血性脑血管病的临床研究

发布时间：2018-05-04 19:14

本文选题：缺血性脑血管病 + 高分辨率磁共振　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:1.应用3.0T高分辨率磁共振(high resolution magnetic resonance imaging,HRMRI)颅内动脉成像,鉴别诊断缺血性脑血管病的病因;2.应用HRMRI研究颅内动脉粥样硬化性斑块分布及其与脑梗死类型的关系,探讨脑梗死发病机制;3.应用HRMRI研究症状性与非症状性大脑中动脉粥样斑块特点;4.应用HRMRI研究青年和中老年缺血性脑血管病患者大脑中动脉粥样斑块分布间关系。方法:按照入选和排除标准,纳入2015.10至2016.12月就诊皖南医学院附属弋矶山医院神经内科(二)的症状性缺血性脑血管病病例49例。患者入院后完善血生化检查,并统计年龄、性别、病史等基线资料。再进行常规头颅核磁共振(magnetic resonance imaging,MRI)检查明确短暂性脑缺血发作(transient ischemic attack,TIA)和脑梗死诊断,弥散加权像(diffusion weighted imaging,DWI)检查确定脑梗死类型,磁共振血管成像(magnetic resonance angiography,MRA)检查选取目标血管。进一步根据MRA定位对目标血管行HRMRI检查,包括双反转恢复T1加权像(double inverse recovery T1 weighted image,DIR T1WI)和快速自旋回波T2加权像(turbo spin echo T1 weighted image,TSE T2WI)。由两名影像科医师对HRMRI检查结果行脑血管病病因诊断,评估诊断一致性和重复性。将大脑中动脉(middle cerebral artery,MCA)斑块位置分为上侧、下侧、腹侧和背侧,基底动脉(basilar artery,BA)斑块位置分为腹侧和背侧,研究颅内动脉粥样硬化斑块的分布位置,斑块位置和脑梗死类型的关系;进一步研究症状性和非症状性大脑中动脉粥样斑块分布关系。将49例患者划分为青年组(≤45岁)和中老年组(45岁),探究两组间大脑中动脉粥样斑块分布特点。结果:1.在49例患者中,男性35例(71.43%),女性14例(28.57%),年龄28-76岁,平均53.14±11.03岁;患者中高血压31例(63.3%),糖尿病13例(26.5%),吸烟26例(53.1%),饮酒27例(55.1%)。其中,青年组中高血压病比例为30%,而中老年组中高血压病比例高达71.79%,两组高血压病患病率存在差异(P0.05)。2.44例(89.80%)诊断动脉粥样硬化,MCA 35例,BA 9例;3例(6.12%)诊断夹层,2例MCA,1例BA;诊断烟雾病2例(4.08%),两位医师对动脉粥样硬化诊断的组内一致性分别是?甲=0.782(CI 0.611-0.930),?乙=0.847(CI 0.674-0.967),组间一致性为?=0.814(CI 0.640-0.961)。3.DWI诊断穿支梗死22例(62.86%),皮质支梗死6例(17.14%),分水岭梗死7例(20%)(?2=7.233,p0.05);27例MCA供血区梗死中穿支梗死16例(59.26%),皮质支梗死4例(14.81%),分水岭梗死7例(25.93%),三种梗死斑块位于上侧、下侧、腹侧(10例vs.1例vs.5例,2例vs.2例vs.0例,0例vs.1例vs.6例),?2=13.012,p0.01。8例BA的图像分析,背侧斑块6例(75%),引起皮质支梗死4例,皮层梗死2例,均是腹侧斑块。4.症状组35条MCA,斑块分布于上侧10条(28.57%)、下侧7条(20%)、腹侧14条(40%)和背侧4条(11.43%),非症状组29条MCA斑块中上侧壁3条(10.34%),下侧壁15条(51.72%),腹侧壁6条(20.69%)和背侧壁5条(17.24%),?2=9.323,p0.05。T1序列中,症状组高信号显著多于非症状组(18条vs.6条),?2=6.394,p0.05。5.青年组中MCA斑块分布于上侧3条(21.43%)、下侧3条(21.43%)、腹侧5条(35.71%)和背侧3条(21.43%),中老年组中MCA斑块分布于上侧10条(20%)、下侧19条(38%)、腹侧15条(30%)和背侧6条(12%),两组间斑块位置无明显差异(?2=1.944,P0.05)。结论:1.运用3.0T HRMRI能够对缺血性脑血管病病因进行鉴别诊断,并且具有较好的一致性和重复性。2.动脉粥样硬化性病变是缺血性脑血管病最主要病因,MCA斑块多分布于血管壁的下侧和腹侧,上侧壁斑块与穿支梗死相关,而分水岭梗死斑块则多分布于腹侧壁,BA斑块倾向于分布血管的背侧壁,多引起穿支梗死。3.症状性大脑中动脉斑块与非症状性相比,斑块多分布于血管的上侧、腹侧壁,斑块内高信号比例也明显增高。4.青年缺血性脑脑血管病患者和中老年缺血性脑脑血管病患者相比,中老年组高血压患病比例高,两组间大脑中动脉粥样斑块分布位置无明显差异。
[Abstract]:Objective: 1. the etiology of ischemic cerebrovascular disease was identified by 3.0T high resolution magnetic resonance imaging (HRMRI) intracranial artery imaging. 2. the relationship between the distribution of atherosclerotic plaque and the type of cerebral infarction was studied with HRMRI, and the pathogenesis of cerebral infarction was discussed; 3. the symptoms of HRMRI were used to study the symptoms of cerebral infarction. Characteristics of atherosclerotic atherosclerotic plaque in the middle cerebral artery; 4. HRMRI was used to study the distribution of atherosclerotic plaques in the middle cerebral arteries of young and middle-aged patients with ischemic cerebrovascular disease. Methods: according to the criteria of admission and exclusion, the symptomatic ischemia of the neurology department of the affiliated Yi La Shan Hospital, Wangnan Medical College, from 2015.10 to 2016.12 months was included. 49 cases of sexual cerebrovascular disease. After admission to the hospital, the blood biochemical examination was perfected and the baseline data of age, sex, and history were counted. The routine head magnetic resonance (magnetic resonance imaging, MRI) was used to identify the transient ischemic attack (transient ischemic attack, TIA) and the diagnosis of cerebral infarction, and the diffusion-weighted image (diffusion weighted imag). Ing, DWI) check the type of cerebral infarction, magnetic resonance angiography (magnetic resonance angiography, MRA) check the target blood vessels. Further, according to the MRA location, the target blood vessels are examined by HRMRI, including the double inversion to restore the T1 weighted image (double inverse recovery) and the fast spin echo weighted image. Echo T1 weighted image, TSE T2WI). The diagnosis of the pathogeny of cerebrovascular disease was performed by two imaging physicians on the results of HRMRI examination. The diagnostic consistency and repeatability were evaluated. The position of the middle cerebral artery (middle cerebral artery, MCA) was divided into the upper, lower, ventral and dorsal, and the base artery (basilar) plaque was divided into the ventral side and the dorsal side. To study the distribution position of atherosclerotic plaque, the relationship between plaque position and cerebral infarction type, and further study the distribution of atherosclerotic plaque in the symptomatic and non symptomatic cerebral artery. 49 patients were divided into young group (less than 45 years old) and middle aged and elderly group (45 years old). The distribution of atherosclerotic plaque in the two groups was investigated. Results: 1 Among the 49 patients, 35 were male (71.43%), 14 (28.57%) women, 28-76 years old, with an average of 53.14 + 11.03 years, 31 (63.3%), 13 diabetes mellitus (26.5%), smoking 26 cases (26.5%), smoking 26 cases, and alcohol drinking cases in the young group. The prevalence rate was different (P0.05).2.44 (89.80%) diagnosis of atherosclerosis, MCA 35 cases, BA 9 cases, 3 cases (6.12%) diagnosis of interlayer, 2 cases of MCA, 1 cases of BA, diagnosis of moyamoya disease (4.08%), two physicians in the diagnosis of atherosclerosis, =0.782 (CI 0.611-0.930), B =0.847 (CI 0.674-0.967), the conformance of group is? CI 0.640-0.961).3.DWI diagnosed perforating infarction in 22 cases (62.86%), cortical branches infarction in 6 cases (17.14%), watershed infarcts in 7 cases (20%) (? 2=7.233, P0.05); 27 cases of MCA blood supply area perforating infarction 16 cases (59.26%), 4 cases (14.81%) of cortical branches infarction, 6 infarcts in the upper, lower and ventral cases of vs.1 cases, vs.1 cases, vs.5 cases. Vs.2 cases vs.0, 0 vs.1 cases vs.6 cases, 2=13.012, p0.01.8 cases BA image analysis, 6 cases of dorsal plaque (75%), cortical branches infarction, 2 cases of cortical infarct, 35 MCA in the abdominal plaque.4. symptom group, 10 plaques in the upper side (28.57%), inferior 7 (20%), 14 (40%) and dorsal 4 (11.43%) in the ventral side, and the upper MCA plaque in the non symptomatic group. The lateral wall 3 (10.34%), the lower lateral wall 15 (51.72%), the ventral wall 6 (20.69%) and the dorsal side wall 5 (17.24%), 2=9.323, p0.05.T1, the symptom group was significantly more high signal than the non symptomatic group (18 vs.6),? 2=6.394, the MCA plaque in the p0.05.5. youth group was 3 (21.43%), inferior 3 (21.43%), ventral 5 The MCA plaques in the middle and old age group were 10 (20%), 19 (38%) in the lower side, 15 in the ventral side (30%) and 6 in the back (12%). There was no significant difference between the two groups (? 2=1.944, P0.05). Conclusion: 1. using 3.0T HRMRI can be used to differentiate the etiology of ischemic cerebrovascular disease, and it has good consistency and repeatability of.2. atherosclerosis. The most important cause of ischemic cerebrovascular disease is sexual disease. MCA plaques are mostly distributed on the lower and ventral sides of the vascular wall. The plaque of the upper wall is associated with perforating infarction, while the watershed infarcts are mostly distributed on the ventral wall, and the plaque of BA tends to distribute the dorsal wall of the blood vessels, causing the perforating branches to die.3. symptomatic plaque and the non symptomatic phase of the cerebral artery. The proportion of plaques distributed on the upper side of the blood vessels, the ventral wall, and the high signal ratio in the plaques increased obviously. Compared with the patients with ischemic cerebrovascular disease in.4. youth and the elderly patients with ischemic cerebrovascular disease, the proportion of hypertension in the middle aged and elderly groups was high, and there was no significant difference in the distribution of the plaque in the middle cerebral arteries between the two groups.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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