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论著-头颈部

HR-MRI在复发性脑 卒中患者中的应用

作者:师占红1 王洪亮2 武 君3 闫华为2

所属单位:1.河南科技大学第一附属医院急诊 科 (河南 洛阳 471023) 2.河南科技大学第三附属医院神经 内科 (河南 洛阳 471003) 3.河南科技大学第三附属医院影像 科 (河南 洛阳 471003)

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摘要

目的 应用3.0T高分辨磁共 振(HR-MRI)分析复发性脑卒中颈动脉 斑块特征。方法 回顾性收集2015年6 月-2017年3月我院68例急性缺血脑卒中 患者临床资料,所有患者均行3.0T HRMRI 检查,根据既往是否存在缺血性脑 卒中发作史分为初发组(n=32)和复发组 (n=36),比较两组斑块负荷及斑块成分 差异。结果 斑块负荷上,两组管腔面 积、管壁面积、管壁厚度、血管总面 积、管腔狭窄率比较差异无统计学意义 (P>0.05),但复发组较初发组管壁标准 化指数(NWI)明显增高(P<0.05)。斑块成 分上,两组斑块脂质坏死核心、钙化比 例比较差异无统计学意义(P>0.05),但 复发组较初发组斑块内出血、纤维帽破 裂比例明显增大(P<0.05)。结论 HR-MRI 可有效评估复发脑卒中患者颈动脉斑块 特征,对脑卒中再发风险评估及预防有 着重要意义。

Objective To analyze the characteristics of carotid plaques in patients with recurrent stroke by 3.0T high resolution magnetic resonance imaging (HR-MRI). Methods The clinical data of 68 patients with acute ischemic stroke who were admitted to the hospital from June 2015 to March 2017 were analyzed retrospectively. All patients were examined by 3.0T HR-MRI. According to the history of ischemic stroke, the patients were divided into the primary attack group (n=32) and the recurrence group (n=36). The plaque load and plaque composition were compared between the two groups. Results There was no significant difference in the area of lumen, the area and thickness of wall, total vessel area and lumen stenosis rate between the two groups (P>0.05), but the normalized wall index (NWI) of the recurrence group was significantly higher than that of the primary attackgroup (P<0.05). In terms of plaque composition, there was no significant difference between the two groups in plaque lipid necrosis core and calcification ratios (P>0.05), but the proportions of bleeding in plaque and fibrous cap rupture in the recurrence group were significantly higher than those in the primary attack group (P<0.05). Conclusion HR-MRI can effectively evaluate the characteristics of carotid artery plaques in patients with recurrent stroke, which is of great significance for the risk assessment and prevention of recurrent stroke.

【关键词】缺血性脑卒中;颈动脉粥样 硬化;高分辨率磁共振;复发

【中图分类号】R543.4

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2018.05.006

前言

动脉硬化粥样硬化是引起缺血性脑卒中发生的主要原因之一,以 往研究主要关注动脉管腔狭窄程度,而近年研究发现,颈动脉管腔狭 窄程度在评估斑块性质及预测卒中风险上作用有限,而易损斑块形 成在卒中发生中发挥着重要作用[1]。高分辨磁共振(high-resolution magnetic resonance imaging,HR-MRI)是检查颈动脉粥样硬化的常见 检查手段,能够评估斑块性质,预测卒中发生风险,但目前临床关于 复发性脑卒中患者颈动脉斑块特征的报道仍较少见[2]。本研究采用HRMRI分析初发与复发卒中患者颈动脉斑块特征差异,旨在评估卒中复发 风险,为临床防治提供指导。现报告如下。