症状性颅内动脉狭窄的高分辨磁共振及阴阳类证分型研究
发布时间：2018-11-27 20:54
【摘要】：目的： 应用3.0T高分辨率磁共振成像(high resolution magnetic resonance imaging, HR-MRI)探讨症状性颅内动脉粥样硬化性狭窄的动脉管壁和斑块特性及血管内介入治疗对动脉管壁和斑块性质的影响；同时观察急性缺血性中风患者的阴阳类证分型与其影像学相关指标是否存在相关性。 方法： 1.回顾性的分析2011年2月至2014年2月收治的已行3. OT HR-MRI检查的症状性颅内动脉粥样硬化性狭窄患者的一般资料及HR-MRI资料。对所纳入患者的性别、年龄、危险因素、狭窄部位、临床症状、阴阳类证及斑块性质进行频数分布描述性分析。 2.根据HR-MRI扫描结果粗略测量出动脉最狭窄处及参考处血管面积(VA),计算出重构率RI=最狭窄处VA/参考处VA,设定RI≥1.05为PR组,RI1.05为非PR组,对比分析两组之间性别、年龄、危险因素、狭窄部位、临床症状及斑块性质是否存在差异。 3.对所纳入患者中已行血管内介入治疗,并于手术前后均有行HR-MRI检查患者的手术前后3.OT HR-MRI结果进行分析,探讨血管内介入治疗前后颅内动脉管壁和斑块性质的变化。 4.对符合纳入标准患者的阴阳类证分型进行构成比分析,并对阴阳类证与某些影像学指标的关系予以研究。 结果： 1.本研究共纳入22例符合条件的患者,其中男性17人,女性5人,平均年龄59.27±8.795岁；脑梗死患者15例,TIA患者7例；BA狭窄12例,MCA狭窄10例；合并高血压病17例,糖尿病10例,血脂异常14例,既往卒中6例,有吸烟者11例；其中阴类证患者16例,阳类证患者6例。22例患者的靶病变处HR-MRI上均可见不同程度的偏心斑块；在T1WI上,2例可见点状低信号,提示钙化可能,1例可见斑块内高信号,考虑斑块内出血可能；15例在T2WI上可见临近管腔的高信号带,考虑为纤维帽成分；7例在压脂像上可见斑块内信号明显抑制,考虑斑块内脂质核心形成；注射对比剂后,16例在CE-T1WI像上可见强化。 2.本研究22例患者中,狭窄处血管正性重构15例,非正性重构7例。PR组与非PR组之间危险因素的比较中,PR组糖尿病患者更多,具有统计学差异(P=0.045)。两组之间年龄、性别、其他危险因素、狭窄部位及临床症状的比较无统计学意义。PR组与非PR组之间斑块性质的比较显示,PR组可见更多的脂质核心及强化,两者之间的差异均具有统计学意义。 3.本研究22例患者中行血管内介入治疗的7例,行单纯Gateway球囊扩张治疗1例,行Gateway球囊扩张+Wingspan支架成形术治疗6例。1例行单纯球囊扩张治疗的病例,手术后HR-MRI可见斑块性质变得不稳定。6例行球囊扩张+支架成形术治疗的患者,其中1例术后HR-MRI提示斑块可能存在变形和移位,斑块性质同术前,仍不稳定；1例术后HR-MRI提示仍有偏心斑块存在,但性质较稳定；4例术后HR-MRI提示斑块消失,管腔通畅,支架与血管内膜融合良好。所有患者随访时间均在半年以上,均没有再发生同一动脉供血区的缺血和卒中事件。 4.本研究中阴类证患者共16例,阳类证患者共6例。阴阳类证与性别、年龄、不同卒中危险因素、狭窄部位、斑块性质及血管重构型之间的关系均无统计学意义(P0.05)。 结论： 1.在一定程度上,高分辨率磁共振成像技术可以显示颅内动脉管壁结构及斑块性质,并通过压脂成像及增强扫描成像可以对斑块的稳定性进行初步的评估,但其准确性有待提高。 2.症状性颅内动脉粥样硬化性狭窄患者中PR更为多见,相比之下非PR虽然所占比例不高,但确实存在。糖尿病有可能是导致PR的一个重要因素,而且在PR患者中可以见到更多的斑块内脂质核心及斑块强化,提示正性重构的斑块不稳定。 3.单纯球囊扩张可改变颅内动脉管壁的结构,可能使斑块变得不稳定。支架成形术由于支架的贴附作用,对保持管壁结构的稳定性有益。3.0T HR-MRI技术可较清晰的显示血管内介入治疗前后动脉管壁和斑块特征的变化,可用于评估血管内介入治疗对颅内动脉管壁结构和斑块的的影响。 4.急性缺血性中风患者中阴类证更为多见。阴类证与阳类证的比较中性别、年龄、危险因素、狭窄部位及斑块性质均无明显差异,提示阴阳类证分型具有普遍意义,其反映的是患者全部病理因素的综合表现,体现了中医学的整体观念。
[Abstract]:Purpose: Application of high resolution magnetic resonance imaging (HR-MRI) in symptomatic intracranial atherosclerosis with high resolution magnetic resonance imaging (HR-MRI) In response, the positive and negative types of the patients with acute ischemic stroke were observed to be related to their imaging-related indexes. Sex. Method: 1. Retrospective analysis from February 2011 to February 2014 General data and HR for symptomatic intracranial atherosclerotic stenosis who have been treated with 3. OT HR-MRI MRI data. Frequency distribution of sex, age, risk factors, stenosis, clinical symptoms, yin-yang and plaque properties of the included patient Descriptive analysis. 2. The blood vessel area (VA) at the most narrow artery and the reference area of the artery was roughly measured according to the HR-MRI scan results. The reconstruction rate RI was calculated as the VA at the most narrow place, VA at the reference place, and the RI-1.05 was the PR group, and the R1.1. 05 was the non-PR group, and the sex, age, risk between the two groups were compared and analyzed. Factors, Stenosis, Clinical Symptoms, and Plaque Whether there was a difference in quality. 3. Intravascular interventional therapy was performed on the included patients, and before and after the operation, the results of the 3. OT HR-MRI were analyzed before and after the operation, and the intracranial arterial tubes before and after the endovascular intervention were discussed. The change of the property of the wall and the plaque. 4. The composition ratio analysis of the type of yin and yang in the standard patient is made, and the yin and yang syndrome and some shadow like the finger of learning The results were as follows: 1. A total of 22 eligible patients were included in the study, including 17 males and 5 females, with an average age of 59. 27 and 8. 795 years; 15 patients with cerebral infarction, 7 patients with TIA, 12 patients with BA stenosis and 10 MCA stenosis; and There were 17 cases of hypertension, 10 cases of diabetes, 14 cases of dyslipidemia, 6 cases of prior stroke and 11 cases of smokers. On T 1WI, 2 cases of low-point low-signal showed that calcification was possible, 1 case of high signal in the visible plaque, considering the possibility of intraplaque internal hemorrhage, 15 cases of high signal band near the tube cavity on T2WI were considered as fiber cap components, and 7 cases of intraplaque signal were observed on the pressure-fat image. obvious inhibition, taking into account the core formation of the lipid in the plaque; after injection of the contrast agent, 16 an enhancement was seen in the CE-T1WI image. 2. Of the 22 patients in this study, the stenosis In the comparison of the risk factors between the PR and non-PR groups, there were more patients with diabetes in the PR group than in the non-PR group. with statistical difference (P = 0.045). Age, sex, other risk factors between the two groups, narrow There was no statistical significance between the narrow part and the clinical symptoms. The comparison of the plaque properties between the PR group and the non-PR group showed that the PR group can see more lipid core and strong The difference between the two groups was statistically significant. 6 cases were treated with simple balloon dilatation, and the post-operative HR-MRI showed that the properties of the plaque were unstable. 6 cases of patients treated with balloon dilatation + stent-plasty, 1 of the patients with the post-operative HR-MRI showed that the plaque could be deformed and displaced, and the properties of the plaque were not stable before and after the operation; 1 The post-operative HR-MRI showed the presence of the eccentric patch, but the character was stable, and the HR-MRI in 4 cases showed the plaque. disappeared, the tube cavity is smooth, the stent is well fused with the blood vessel, all the patients follow-up time is more than half a year, none There were ischemia and stroke events in the same arterial blood supply area. 4. In the study, there were 16 cases of yin-yang syndrome and 6 cases of male-type syndrome. The yin-yang syndrome and sex, age, risk factors of different stroke, the narrow part, the nature of the plaque and the weight of the blood vessel configurational Conclusion: 1. In a certain extent, the high-resolution magnetic resonance imaging technique can display the structure of the tube wall of the intracranial artery and the character of the plaque, and can be used to image and enhance the scanning imaging by the pressure-fat imaging and the enhanced scanning. in order to evaluate the stability of the plaque, the accuracy of the plaque is to be improved. R is more common, compared with non-PR, although the proportion of non-PR is not high, but does exist. Diabetes is likely to be an important factor in the PR, and more can be seen in PR patients The core of the plaque and the enhancement of the plaque in the plaque suggest that the plaque of the positive reconstruction is not stable. The simple balloon expansion can change the structure of the tube wall of the intracranial artery, which can make the plaque unstable. The stent is beneficial to the stability of the tube wall structure due to the attachment of the stent. The 3. 0T HR-MRI technique can show the changes of the arterial wall and the plaque characteristics before and after the intravascular interventional therapy. and can be used for evaluating the intravascular interventional treatment on the tube wall of the intracranial artery. The effect of the structure and plaque in the patients with acute ischemic stroke is more obvious. The sex, age, risk factors, the narrow part and the character of the plaque in the comparison of the syndrome of yin and yang have no significant difference, and it is suggested that the type of yin and yang is of universal significance.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
本文编号：2362010
[Abstract]:Purpose: Application of high resolution magnetic resonance imaging (HR-MRI) in symptomatic intracranial atherosclerosis with high resolution magnetic resonance imaging (HR-MRI) In response, the positive and negative types of the patients with acute ischemic stroke were observed to be related to their imaging-related indexes. Sex. Method: 1. Retrospective analysis from February 2011 to February 2014 General data and HR for symptomatic intracranial atherosclerotic stenosis who have been treated with 3. OT HR-MRI MRI data. Frequency distribution of sex, age, risk factors, stenosis, clinical symptoms, yin-yang and plaque properties of the included patient Descriptive analysis. 2. The blood vessel area (VA) at the most narrow artery and the reference area of the artery was roughly measured according to the HR-MRI scan results. The reconstruction rate RI was calculated as the VA at the most narrow place, VA at the reference place, and the RI-1.05 was the PR group, and the R1.1. 05 was the non-PR group, and the sex, age, risk between the two groups were compared and analyzed. Factors, Stenosis, Clinical Symptoms, and Plaque Whether there was a difference in quality. 3. Intravascular interventional therapy was performed on the included patients, and before and after the operation, the results of the 3. OT HR-MRI were analyzed before and after the operation, and the intracranial arterial tubes before and after the endovascular intervention were discussed. The change of the property of the wall and the plaque. 4. The composition ratio analysis of the type of yin and yang in the standard patient is made, and the yin and yang syndrome and some shadow like the finger of learning The results were as follows: 1. A total of 22 eligible patients were included in the study, including 17 males and 5 females, with an average age of 59. 27 and 8. 795 years; 15 patients with cerebral infarction, 7 patients with TIA, 12 patients with BA stenosis and 10 MCA stenosis; and There were 17 cases of hypertension, 10 cases of diabetes, 14 cases of dyslipidemia, 6 cases of prior stroke and 11 cases of smokers. On T 1WI, 2 cases of low-point low-signal showed that calcification was possible, 1 case of high signal in the visible plaque, considering the possibility of intraplaque internal hemorrhage, 15 cases of high signal band near the tube cavity on T2WI were considered as fiber cap components, and 7 cases of intraplaque signal were observed on the pressure-fat image. obvious inhibition, taking into account the core formation of the lipid in the plaque; after injection of the contrast agent, 16 an enhancement was seen in the CE-T1WI image. 2. Of the 22 patients in this study, the stenosis In the comparison of the risk factors between the PR and non-PR groups, there were more patients with diabetes in the PR group than in the non-PR group. with statistical difference (P = 0.045). Age, sex, other risk factors between the two groups, narrow There was no statistical significance between the narrow part and the clinical symptoms. The comparison of the plaque properties between the PR group and the non-PR group showed that the PR group can see more lipid core and strong The difference between the two groups was statistically significant. 6 cases were treated with simple balloon dilatation, and the post-operative HR-MRI showed that the properties of the plaque were unstable. 6 cases of patients treated with balloon dilatation + stent-plasty, 1 of the patients with the post-operative HR-MRI showed that the plaque could be deformed and displaced, and the properties of the plaque were not stable before and after the operation; 1 The post-operative HR-MRI showed the presence of the eccentric patch, but the character was stable, and the HR-MRI in 4 cases showed the plaque. disappeared, the tube cavity is smooth, the stent is well fused with the blood vessel, all the patients follow-up time is more than half a year, none There were ischemia and stroke events in the same arterial blood supply area. 4. In the study, there were 16 cases of yin-yang syndrome and 6 cases of male-type syndrome. The yin-yang syndrome and sex, age, risk factors of different stroke, the narrow part, the nature of the plaque and the weight of the blood vessel configurational Conclusion: 1. In a certain extent, the high-resolution magnetic resonance imaging technique can display the structure of the tube wall of the intracranial artery and the character of the plaque, and can be used to image and enhance the scanning imaging by the pressure-fat imaging and the enhanced scanning. in order to evaluate the stability of the plaque, the accuracy of the plaque is to be improved. R is more common, compared with non-PR, although the proportion of non-PR is not high, but does exist. Diabetes is likely to be an important factor in the PR, and more can be seen in PR patients The core of the plaque and the enhancement of the plaque in the plaque suggest that the plaque of the positive reconstruction is not stable. The simple balloon expansion can change the structure of the tube wall of the intracranial artery, which can make the plaque unstable. The stent is beneficial to the stability of the tube wall structure due to the attachment of the stent. The 3. 0T HR-MRI technique can show the changes of the arterial wall and the plaque characteristics before and after the intravascular interventional therapy. and can be used for evaluating the intravascular interventional treatment on the tube wall of the intracranial artery. The effect of the structure and plaque in the patients with acute ischemic stroke is more obvious. The sex, age, risk factors, the narrow part and the character of the plaque in the comparison of the syndrome of yin and yang have no significant difference, and it is suggested that the type of yin and yang is of universal significance.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
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