大脑中动脉粥样硬化斑块特征与梗死类型的相关性

摘要

目的 利用3.0T高分辨率磁共振成像(HRMRI)对大脑中动脉粥样硬化斑块的特征进行研究,探讨斑块特征与患者梗死类型的相关性.资料与方法 选取49例行颅内动脉HRMRI的动脉粥样硬化患者,分析其双侧大脑中动脉的斑块形态、斑块分布及斑块强化程度.按斑块强化程度将患者分为明显强化组和非明显强化组,比较两组患者的临床资料,分析不稳定斑块的临床危险因素.根据扩散加权成像结果将大脑中动脉供血区急性梗死患者分为单穿支动脉阻塞、多穿支动脉阻塞及动脉栓塞,分析不同梗死类型的斑块特征.结果 49例患者共发现位于大脑中动脉粥样硬化斑块65处,其中62处(95.4％)为偏心性斑块,斑块最常见于腹侧壁(31处,50.0％).明显强化组中高密度脂蛋白胆固醇降低的患者比例(56.7％)明显高于非明显强化组(26.3％),差异有统计学意义(P＜0.05).动脉栓塞组中明显强化斑块的发生率(88.9％)明显高于非动脉栓塞组(单穿支动脉阻塞及多穿支动脉阻塞,36.4％),差异有统计学意义(P＜0.05).结论 大脑中动脉粥样硬化斑块的分布位置与缺血性卒中事件的发生密切相关,斑块强化程度能够反映斑块的稳定性.利用HRMRI能够在一定程度上预测缺血性卒中事件的发生,并推测其梗死类型.%Purpose To characterize the middle cerebral artery atherosclerotic plaque and investigate its relationship with infarction patterns by using 3.0T high resolution magnetic resonance imaging (HRMRI).Materials and Methods Forty-nine patients with intracranial atherosclerosis underwent HRMRI.The characteristics of the plaques of middle cerebral artery were investigated,including morphology,distribution and enhancement.Patients were categorized as two groups (strong/mild and none) according to the strength of plaque enhancement,then clinical data were compared between the two groups and the risk factors were investigated.Acute infarction was classified as three subtypes (single/multiple perforating artery occlusion/arterial embolism) basedon diffusion weighted imaging,and the plaque characteristics of each subtype were investigated.Results Sixty-five plaques were identified in middle cerebral artery of 49 patients,62 plaques (95.4％) were eccentric,31 plaques (50.0％) were located at the ventral wall.Patients with low levels of high-density lipoprotein were significantly more prevalent in strong enhancement group (56.7％ vs.26.3％,P＜0.05).The percentage of strong enhancement plaque in arterial embolism group (88.9％) was significantly higher than non-arterial embolism group (36.4％) (P＜0.05).Conclusion Middle cerebral artery plaque distribution is correlated with ischemic stroke,strong enhancement plaque is associated with its vulnerability.HRMRI can provide information to predict the ischemic event and infarction pattern.