高分辨核磁共振成像在脑梗死TOAST分型中的应用价值

发布时间：2018-06-25 21:27

本文选题：高分辨核磁共振成像 + TOAST分型　；参考：《石河子大学》2017年硕士论文

【摘要】：目的利用高分辨核磁成像对颅内动脉血管病变情况进行分析,包括斑块(分布、重构、出血)、血管狭窄(部位、程度及有无闭塞)等影像学特点的检测结果;评价高分辨核磁在脑梗死TOAST分型中的应用价值。方法选取石河子大学医学院第一附属医院神经内科收治的经CT/MRI确诊为急性脑梗死的患者60例,入院后收集患者的一般资料,依据实验室相关检查、颈动脉超声、动态心电图、动态血压及患者的既往病史、症状、体征行初步的TOAST分型,此后行高分辨核磁共振成像(T1WI、T2WI、PDWI、FLAIR、CUBE-T1序列)检查,评价颅内动脉血管及颈动脉血管内膜有无增厚、狭窄、斑块、斑块的性质、斑块的分布及斑块有无重构及出血等,经影像科专家读片、审核、作出诊断报告后,再次行TOAST分型,分析脑梗死患者五种分型的一般资料、一般普通检查与高分辨核磁共振成像所占百分比的比较,评估高分辨核磁共振成像对脑梗死分型的意义。结果(1)60例患者行一般检查前,一般资料的比较中,高血压、糖尿病、冠心病等在大动脉粥样硬化型、小动脉闭塞型脑梗死中所占比例偏高;五组患者的低密度脂蛋白、同型半胱氨酸、胱抑素C等比较差异有统计学意义(P0.05);(2)颅内外血管的高分辨核磁共振检查发现:双侧颅内动脉以大脑前、中、后的动脉粥样硬化为主,颅外动脉的粥样硬化、斑块、狭窄表现也集中在大动脉粥样硬化组、小动脉闭塞组;(3)行一般普通检查与高分辨核磁五组分型所占的百分比差异无意义(P0.05);大动脉粥样硬化型、小动脉闭塞型所占的比例有所上升,而不明原因患者所占的比例下降了5%,心源性栓塞型、已知原因型患者所占的比例无变化。结论1高分辨核磁成像对颅内外血管病变具有较高的识别度。2高分辨核磁对缺血性脑血管病的病因、诊断、分型具有重要意义,为脑梗死事件的诊治、二级预防提供重要参考依据,值得临床推广。
[Abstract]:Objective to analyze the vascular lesions of intracranial arteries by high-resolution magnetic resonance imaging (HRNMR), including the findings of plaque (distribution, remodeling, hemorrhage), stenosis (location, degree and occlusion), and so on. To evaluate the value of high resolution magnetic resonance (HRNMR) in the classification of TOAST in cerebral infarction. Methods Sixty patients with acute cerebral infarction diagnosed by CT / MRI were selected from the Department of Neurology, the first affiliated Hospital of Shihezi University Medical College. The general data of the patients were collected after admission. The data were collected according to the relevant laboratory examination, carotid ultrasound and dynamic electrocardiogram. Ambulatory blood pressure (ABBP) and previous history, symptoms and signs of the patients were classified by toast, and then high-resolution magnetic resonance imaging (T1WII-T2WIP) was performed to evaluate the thickening, stenosis and plaque of intracranial artery and carotid artery intima. The character of plaque, the distribution of plaque, whether there were remodeling and bleeding, etc. After the image expert read, examined and made the diagnosis report, the TOAST classification was performed again, and the general data of the five types of cerebral infarction patients were analyzed. To evaluate the significance of high resolution magnetic resonance imaging (HRMRI) in the classification of cerebral infarction by comparing the percentage of conventional MRI and high resolution MRI. Results (1) the proportion of hypertension, diabetes and coronary heart disease in cerebral infarction of arteriosclerosis type and arteriole occlusion type was higher than that of general data before general examination in 60 patients, the low density lipoprotein (LDL) of the five groups was low density lipoprotein (LDL), low density lipoprotein (LDL) in the five groups, The differences of homocysteine and cystatin C were statistically significant (P0.05); (2). The results of high resolution magnetic resonance imaging showed that bilateral intracranial arteries were mainly atherosclerosis in anterior, middle and posterior cerebral arteries, and atherosclerosis in extracranial arteries. Plaque, stenosis also concentrated in the arteriosclerosis group, arteriole occlusion group; (3) the general examination and high-resolution nuclear magnetic resonance five groups of the percentage difference is not significant (P0.05); large artery atherosclerosis type, The proportion of arteriole occlusion type increased, while the proportion of unknown cause patients decreased by 5%, cardiogenic embolism type, the proportion of known cause type patients did not change. Conclusion (1) High resolution nuclear magnetic resonance imaging has a high degree of recognition for intracranial and extracranial vascular lesions. 2 High resolution nuclear magnetic resonance imaging is of great significance in the etiology, diagnosis and classification of ischemic cerebrovascular diseases, and is of great significance in the diagnosis and treatment of cerebral infarction events. The two-level prevention provides important reference basis and is worth popularizing in clinic.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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