高分辨率磁共振对大脑中动脉斑块特征及其对梗死类型、机制预测价值的研究
发布时间：2019-01-02 19:04
【摘要】：目的:运用3.0T高分辨率磁共振(High-resolution MRI,HR MRI)技术评估大脑中动脉粥样硬化斑块,结合临床表现分析罪犯血管与非罪犯血管之间的斑块特征及差异,并进一步分析斑块分布位置与梗死类型之间的关系,探讨可能的卒中发病机制。方法:收集2014年09月至2017年03月于南昌大学第二附属医院行常规磁共振序列(包括T1WI、T2WI、T2-FLAIR、3D-TOF-MRA、DWI)及大脑中动脉高分辨率扫描序列同时符合入选标准的患者64例。所有患者使用3.0T(GE Signa 3.0T Excite HD Systems)GE8通道线圈扫描经MRA确诊或可疑狭窄的MCA,将纳入患者按照是否存在卒中症状分为有症状及无症状MCA斑块组,然后将扫描的MCA根据是否为梗死灶的责任血管分为罪犯血管组和非罪犯血管组。收集临床资料、实验室检查、斑块特征、狭窄程度及脑梗死类型等,分析有症状MCA组与无症状MCA组之间的临床特点及罪犯血管组与非罪犯血管组的斑块特征差异,同时对斑块分布位置与梗死类型进行分析,探讨可能的卒中机制。所有数据采用SPSS17.0软件进行统计学分析。结果:1、本研究中符合入选标准的患者64例(其中男45例,女19例,年龄位于26-87岁之间,年龄59±12岁)及扫描的MCA 76根。其中,有症状MCA斑块组43例,非症状MCA斑块组21例;罪犯血管组44根,非罪犯血管组32根。有症状组平均年龄为60±14岁,而非症状组为58±7岁,在两组中年龄、性别均无统计学意义(P0.05)。此外,在两组间既往史(包括高血压病史、糖尿病病史、高脂血症、高胱氨酸血症、吸烟史)及实验室检查结果(总胆固醇、甘油三酯、低密度脂蛋白)亦无统计学意义(P0.05)。2、罪犯血管组与非罪犯血管组之间斑块指标包括LA(2.28±1.69 VS 2.31±1.61,P=0.807)、WA(5.70±2.43 VS 5.32±1.58,P=0.444)、VA(7.95±2.97 VS 7.69±2.49,P=0.844)、PB(0.72±0.17 VS 0.72±0.16,P=0.883)、RI(0.75±0.25 VS 0.81±0.24,P=0.324)、狭窄程度(P=0.715)、重塑类型(P=0.854)、斑块分布位置(上壁P=0.845;下壁P=0.084;前壁P=0.966;后壁P=0.389)、表面是否规则(P=0.873)及斑块稳定性(P=0.283)均无统计学意义(P0.05),而两组之间增厚模式存在统计学意义(P0.05),均以偏心性增厚多见,罪犯血管组比例更大。3、扫描的76例斑块中,分别位于上壁32例(42.1%)、下壁30例(39.5%)、前壁7例(9.2%)及后壁7例(9.2%)。统计分析结果显示斑块更常见于上下壁,其中无梗死灶患者斑块以上、下壁为主,皮层下梗死以下壁斑块为主,3例大面积梗死及大部分穿支血管梗死患者的斑块均位于上壁,但差异均无统计学意义(P0.05)。4、纳入的76例斑块中男性占53例(69.7%),女性占23例(30.3%)。斑块各分布位置男女比例无统计学意义(P0.05)。结论:MCA狭窄患者偏心性增厚可能与不稳定斑块有关;斑块位置尤其是上壁斑块,可能有助于判断梗死类型及了解缺血性√事件的基本机制。
[Abstract]:Objective: to evaluate atherosclerotic plaques in middle cerebral artery by using 3.0T high-resolution magnetic resonance imaging (High-resolution MRI,HR MRI) technique, and to analyze the plaque characteristics and differences between convict and non-convict vessels in combination with clinical manifestations. Furthermore, the relationship between plaque location and infarction type was analyzed to explore the possible pathogenesis of stroke. Methods: routine MRI sequences (including T1WIN T2WIT2-FLAIRN 3D-TOF-MRAA) were performed in the second affiliated Hospital of Nanchang University from September 2014 to March 2017. DWI) and high-resolution scan sequence of middle cerebral artery (MCA) in 64 patients who met the inclusion criteria at the same time. All patients were divided into symptomatic and asymptomatic MCA plaque groups according to the presence or absence of stroke symptoms using 3.0T (GE Signa 3.0T Excite HD Systems) GE8 channel coil scanning MCA, diagnosed by MRA or suspected stenosis. The scanned MCA was then divided into the convict group and the non-convict group according to whether the responsible vessels were infarcted or not. The clinical data, laboratory examination, plaque characteristics, degree of stenosis and type of cerebral infarction were collected to analyze the clinical characteristics of symptomatic MCA group and asymptomatic MCA group, and the differences of plaque characteristics between culprit vascular group and non-criminal vascular group. At the same time, the location of plaque distribution and infarction type were analyzed to explore the possible mechanism of stroke. All the data were analyzed by SPSS17.0 software. Results: 1. In this study, 64 patients (45 males and 19 females, aged between 26 and 87 years, 59 卤12 years old) and 76 MCA were included in the study. There were 43 symptomatic MCA plaques, 21 asymptomatic MCA plaques, 44 convict vessels and 32 non-convict vessels. The average age of the symptomatic group was 60 卤14 years old, while that of the non-symptomatic group was 58 卤7 years old. There was no significant difference in age and sex between the two groups (P0.05). In addition, previous history between the two groups (including hypertension, diabetes, hyperlipidemia, hypercysteinemia, smoking history) and laboratory results (total cholesterol, triglyceride), There was also no significant difference in low density lipoprotein (P0.05). The plaque index between the culprit vascular group and the non-convict vascular group included LA (2.28 卤1.69 VS 2.31 卤1.61 VS 0.807), WA (5.70 卤2.43 VS 5.32 卤1.58). Pn0.444), VA (7.95 卤2.97 VS 7.69 卤2.49), PB (0.844), PB (0.72 卤0.17 VS 0.72 卤0.16), RI (0.883), RI (0.75 卤0.25 VS 0.81 卤0.24 VS 0.324), the degree of stenosis was 0.715. The type of remodeling (P0. 854), the location of plaques (P < 0. 845); The inferior wall was 0.084, the anterior wall was 0.966; There was no significant difference in the posterior wall (P < 0. 389), surface regularity (P < 0. 873) and plaque stability (P 0. 283) (P0.05), but there was significant difference in the thickening pattern between the two groups (P 0. 05). The percentage of culprit vessels was much larger. In 76 cases, 32 cases were located in the superior wall (42.1%), 30 cases in the inferior wall (39.5%), 7 cases in the anterior wall (9.2%) and 7 cases in the posterior wall (9.2%). The results of statistical analysis showed that the plaques were more common in the upper and lower wall of the patients with no infarct. The plaques in the subcortical and subcortical infarcts were more common in the patients with large area infarction and most perforating vessel infarction, and the plaques were located in the superior wall in the patients with no infarct foci. However, there was no significant difference between the two groups (P0.05). Among the 76 plaques included, 53 (69.7%) were male and 23 (30.3%) were female. There was no significant difference between male and female in the distribution of plaque (P0.05). Conclusion: eccentric thickening in patients with MCA stenosis may be associated with unstable plaque, and the location of plaque, especially in the upper wall, may be helpful to judge the type of infarction and to understand the basic mechanism of ischemic events.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R445.2
本文编号：2398865
[Abstract]:Objective: to evaluate atherosclerotic plaques in middle cerebral artery by using 3.0T high-resolution magnetic resonance imaging (High-resolution MRI,HR MRI) technique, and to analyze the plaque characteristics and differences between convict and non-convict vessels in combination with clinical manifestations. Furthermore, the relationship between plaque location and infarction type was analyzed to explore the possible pathogenesis of stroke. Methods: routine MRI sequences (including T1WIN T2WIT2-FLAIRN 3D-TOF-MRAA) were performed in the second affiliated Hospital of Nanchang University from September 2014 to March 2017. DWI) and high-resolution scan sequence of middle cerebral artery (MCA) in 64 patients who met the inclusion criteria at the same time. All patients were divided into symptomatic and asymptomatic MCA plaque groups according to the presence or absence of stroke symptoms using 3.0T (GE Signa 3.0T Excite HD Systems) GE8 channel coil scanning MCA, diagnosed by MRA or suspected stenosis. The scanned MCA was then divided into the convict group and the non-convict group according to whether the responsible vessels were infarcted or not. The clinical data, laboratory examination, plaque characteristics, degree of stenosis and type of cerebral infarction were collected to analyze the clinical characteristics of symptomatic MCA group and asymptomatic MCA group, and the differences of plaque characteristics between culprit vascular group and non-criminal vascular group. At the same time, the location of plaque distribution and infarction type were analyzed to explore the possible mechanism of stroke. All the data were analyzed by SPSS17.0 software. Results: 1. In this study, 64 patients (45 males and 19 females, aged between 26 and 87 years, 59 卤12 years old) and 76 MCA were included in the study. There were 43 symptomatic MCA plaques, 21 asymptomatic MCA plaques, 44 convict vessels and 32 non-convict vessels. The average age of the symptomatic group was 60 卤14 years old, while that of the non-symptomatic group was 58 卤7 years old. There was no significant difference in age and sex between the two groups (P0.05). In addition, previous history between the two groups (including hypertension, diabetes, hyperlipidemia, hypercysteinemia, smoking history) and laboratory results (total cholesterol, triglyceride), There was also no significant difference in low density lipoprotein (P0.05). The plaque index between the culprit vascular group and the non-convict vascular group included LA (2.28 卤1.69 VS 2.31 卤1.61 VS 0.807), WA (5.70 卤2.43 VS 5.32 卤1.58). Pn0.444), VA (7.95 卤2.97 VS 7.69 卤2.49), PB (0.844), PB (0.72 卤0.17 VS 0.72 卤0.16), RI (0.883), RI (0.75 卤0.25 VS 0.81 卤0.24 VS 0.324), the degree of stenosis was 0.715. The type of remodeling (P0. 854), the location of plaques (P < 0. 845); The inferior wall was 0.084, the anterior wall was 0.966; There was no significant difference in the posterior wall (P < 0. 389), surface regularity (P < 0. 873) and plaque stability (P 0. 283) (P0.05), but there was significant difference in the thickening pattern between the two groups (P 0. 05). The percentage of culprit vessels was much larger. In 76 cases, 32 cases were located in the superior wall (42.1%), 30 cases in the inferior wall (39.5%), 7 cases in the anterior wall (9.2%) and 7 cases in the posterior wall (9.2%). The results of statistical analysis showed that the plaques were more common in the upper and lower wall of the patients with no infarct. The plaques in the subcortical and subcortical infarcts were more common in the patients with large area infarction and most perforating vessel infarction, and the plaques were located in the superior wall in the patients with no infarct foci. However, there was no significant difference between the two groups (P0.05). Among the 76 plaques included, 53 (69.7%) were male and 23 (30.3%) were female. There was no significant difference between male and female in the distribution of plaque (P0.05). Conclusion: eccentric thickening in patients with MCA stenosis may be associated with unstable plaque, and the location of plaque, especially in the upper wall, may be helpful to judge the type of infarction and to understand the basic mechanism of ischemic events.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R445.2
【参考文献】
相关期刊论文 前1条
1 吴立恒;李天晓;冯广森;朱良付;王子亮;薛降宇;白卫星;贺迎坤;;高分辨率磁共振斑块成像与DSA评估症状性大脑中动脉狭窄的比较[J];中国神经精神疾病杂志;2012年05期
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