高分辨磁共振成像在大脑中动脉缺血性卒中的临床应用

发布时间：2018-05-05 01:17

本文选题：高分辨磁共振 + 大脑中动脉　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究通过应用3.0T高分辨率磁共振成像(high resolution magnetic resonance imaging,HRMRI)技术对因动脉粥样硬化而发生缺血性脑卒中患者进行成像,对比双侧大脑中动脉(middle cerebral artery,MCA)分别分析血管狭窄率、斑块负荷、斑块内出血(Intraplaque hemorrhage,IPH)、血管重塑、斑块位置与缺血性脑卒中的相关性,探讨颅内动脉硬化(intracranial atherosclerotic disease,ICAD)患者发生缺血性脑卒中的危险分级因素。方法:起病72小时内就诊的缺血性脑卒中患者,行头部HRMRI检查,选取其中确诊为MCA供血区梗死患者。分别测量及计算入组患者双侧MCA最窄层面及参考层面的血管面积(Vessel area,VA)、管腔面积(Luminal area,LA)、管壁面积(Wall area,WA)、斑块面积(Plaque area,PA)、斑块负荷、狭窄率、重塑指数(remodeling index,RI)等参数,以及评估斑块分布、斑块内出血等特征。结果比较入组患者卒中侧及卒中对侧MCA最窄层面血管面积(VA)两者差异无统计学意义(p0.05);最窄层面管腔面积(LA)卒中侧小于卒中对侧,差异有统计学意义(p0.05);而最窄层面管壁面积(WA)、斑块面积(PA)、斑块负荷及血管狭窄率卒中侧大于卒中对侧,差异有统计学意义(p0.05);卒中侧MCA发生正性重塑26例(44.8%),无明显重塑19例(32.8%),负性重塑13例(22.4%)。卒中对侧MCA发生正性重塑11例(19.0%),无明显重塑39例(67.2%),负性重塑8例(13.8%)。两侧MCA重塑方式比例不同(χ2=14.166,p0.05),且卒中侧正性重塑比例大于卒中对侧;卒中侧:14例(24.1%)斑块位于上壁,15例(25.9%)位于下壁,17例(29.3%)位于腹侧壁,12例(20.7%)位于背侧壁。在卒中对侧:6例(10.3%)斑块位于上壁,24例(41.4%)位于下壁,23例(39.7%)位于腹侧壁,5例(8.6%)位于背侧壁。双侧大脑中动脉分布于下壁和腹侧壁斑块明显多于上壁或背侧壁;卒中侧分布于上壁和背侧壁斑块多于卒中对侧,差异有统计学意义(χ2=8.929,p0.05)。卒中侧16(27.6%)例发生IPH;卒中对侧有3(5.1%)例患者发生斑块内出血。两侧MCA发生斑块内出血的比例不同(χ2=10.637,p0.05),卒中侧要高于卒中对侧。logistic回归分析结果显示血管狭窄率、正性重塑、上壁及侧壁斑块、斑块内出血是动脉硬化患者发生缺血性脑卒中危险因素。结论1.斑块负荷与缺血性脑卒中具有密切相关性;血管狭窄率、血管正性重塑、斑块分布于血管上壁及斑块内出血是缺血性脑卒中的危险因素;2.HRMRI能够更加准确评估动脉粥样硬化管壁状态,预测缺血性脑卒中发生风险。
[Abstract]:Objective: in this study, we used 3.0T high-resolution magnetic resonance imaging technique to image ischemic stroke patients caused by atherosclerosis, and compared the middle cerebral artery (MCA) with middle cerebral artery (MCA) to analyze the rate of vascular stenosis. Plaque load, intraplaque hemorrhage, vascular remodeling, plaque location and ischemic stroke were studied in order to explore the risk factors of ischemic stroke in patients with intracranial arteriosclerosis and intracranial atherosclerotic disease. Methods: the patients with ischemic stroke within 72 hours were examined by HRMRI, and the patients diagnosed as infarct of MCA blood supply area were selected. We measured and calculated the vascular area of bilateral MCA on the narrowest plane and the reference plane, the lumen area, the wall area, the plaque load, the stenosis rate, the remodeling index (RI), and evaluated the plaque distribution. Plaque internal bleeding and other characteristics. Results there was no significant difference between stroke side and stroke contralateral MCA in the narrowest plane vascular area (va), and the narrowest plane lumen area was smaller in stroke side than that in stroke contralateral side, and there was no significant difference between stroke side and stroke contralateral side (P < 0.05). The difference was statistically significant (P 0.05), while the area of the narrowest wall was greater than that of the opposite side of the stroke, and the plaque area was PAA, the plaque load and vascular stenosis rate were larger in the stroke side than in the contralateral side of the stroke. Positive remodeling occurred in 26 patients with MCA, no significant remodeling was found in 19 patients, and negative remodeling occurred in 13 patients. In contralateral MCA, positive remodeling occurred in 11 cases, no significant remodeling occurred in 39 cases (67.2%), and negative remodeling occurred in 8 cases (13.8%). The ratio of bilateral MCA remodeling patterns was different (蠂 ~ 2 ~ 2 ~ (14.166) p _ (0.05), and the ratio of positive remodeling in stroke side was higher than that in the stroke contralateral side, and the plaque was located in the superior wall in 15 cases (25. 9%) in the inferior wall of 17 cases (29. 3%) in the ventral wall of 12 cases (20. 7%) and in the dorsal side wall (20. 7%). On the contralateral side of stroke, the plaques were located in the upper wall (n = 24) and in the superior wall (n = 41.4) in the inferior wall (n = 23) in the inferior wall (n = 39.7) in the ventral wall (n = 5) and in the dorsal wall (n = 5). The distribution of bilateral middle cerebral artery in the inferior wall and ventral wall was significantly more than that in the upper wall or dorsal wall, and the number of plaques in the upper wall and dorsal wall of stroke was more than that in the opposite side of stroke (蠂 ~ 2 = 8.929) (蠂 ~ 2 = 8.929) (P < 0.05). IPH was found in the stroke side (1627.6) and in the contralateral side of the stroke (35.1%). The proportion of plaque hemorrhage in bilateral MCA was different (蠂 ~ 2 ~ 2 ~ (10.637) (P < 0.05). The results of logistic regression analysis showed that the rate of stenosis, positive remodeling, plaque in the upper wall and lateral wall were higher in the stroke side than in the contralateral side. Plaque hemorrhage is a risk factor for ischemic stroke in patients with atherosclerosis. Conclusion 1. Plaque load is closely related to ischemic stroke. Plaque distribution in the superior wall and intraplaque hemorrhage is a risk factor for ischemic stroke. 2. HRMRI can more accurately evaluate the status of atherosclerotic wall and predict the risk of ischemic stroke.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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