高清磁共振研究基底动脉粥样硬化狭窄重构模式在脑桥旁正中梗死中的应用

摘要/Abstract

摘要：

目的应用3.0T高分辨磁共振成像（high resolution magnetic resonance imaging，HRMRI）探讨脑桥旁正中梗死（paramedian pontine infarction，PPI）患者基底动脉管壁特征及重构模式。方法连续入组孤立脑桥旁正中梗死患者30例，行头颅磁共振平扫及头颅磁共振血管成像（magnetic resonance angiography，MRA）检查，并用3.0T HRMRI对基底动脉检查，测量管壁特征并计算重构指数（remodeling index，RI）（最窄处血管面积/参考处血管面积）。RI≤0.95为阴性重构，RI 在 0.95～1.05之间为无重构，RI≥1.05为阳性重构，比较阴性重构和阳性重构的斑块面积、斑块负荷等特点。结果 30例患者在MRA上共发现9例有基底动脉狭窄，21例显示管腔正常，而在HRMRI可发现25例患者有基底动脉粥样硬化性斑块，并可见斑块位于脑桥旁正中梗死责任血管的穿支动脉口。对HRMRI上发现有动脉粥样斑块的25例患者计算RI，其中阴性重构8例，无重构6例，阳性重构11例，比较两组数据，阳性重构组的斑块面积（8.17±4.7）mm2及斑块负荷（29.07±15.03）%均大于阴性重构组的斑块面积（1.08±1.89）mm2及斑块负荷（3.96±6.76）%，差异具有显著性。结论 HRMRI有助于缺血性卒中的病因学分型并评估病变的RI。脑桥旁正中梗死患者基底动脉阴性重构与阳性重构同样常见，阳性重构常合并较大的动脉粥样硬化斑块，且斑块面积及斑块负荷均大于阴性重构。

文章导读： 本研究显示高分辨率磁共振成像技术可以清晰显示脑桥旁正中梗死患者血管斑块的特点及其重构
特点。

关键词: 高分辨磁共振成像; 脑桥旁正中梗死; 动脉粥样硬化; 基底动脉; 重构指数

Abstract:

Objective To investigate the properties and remodeling pattern of basilar artery atherosclerosis in paramedian pontine infarction (PPI) with 3.0T high-resolution magnetic resonance imaging (HRMRI). Methods Thirty consecutive patients with acute paramedian pontine infarction were enrolled from January 2011 to December 2012, all are detected by conventional magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), and HRMRI was performed on the target segment by using a 3.0T MR scanner. Remodeling index (RI) was calculated as vessel area at maximal lumen narrowing (MLN)/reference vessel area. RI ≤0.95 was defined as negative remodeling (NR), 0.95﹤RI ﹤1.05 as intermediate remodeling (IR), and RI ≥1.05 as positive remodeling (PR), wall characteristics were compared between the NR and PR group. Results In 30 patients, 9 arteries were shown stenosis, 21 arteries were shown normal on MRA, while HRMRI detected 25 arteries with plaque, and the basilar artery (BA) plaques at or near the origin of the penetrating artery. Analyze the 25 patients, NR was found in 8 patients, IR in 6 patients, and PR in 11 patients. At MLN sites, compared with lesions with NR, lesions with PR had greater plaque area ([8.17±4.7]mm2 vs [1.08±1.89]mm2, P ﹤0.01), and a greater percent plaque burden ([29.07±15.03]% vs [3.96±6.76]%, P ﹤0.01). Conclusion HRMRI can help assess subtypes of ischemic stroke and the remodeling pattern of BA atherosclerosis. Etiology of PPI is the BA plaque blocking the penetrating artery. In patients with PPI, NR and PR lesions are some frequently observed, and PR lesions have a greater wall area and plaque burden than NR lesions.

Key words: High resolution magnetic resonance imaging; Paramedian pontine infarction; Atherosclerosis basilar artery; Remodeling index

王江波1，江炜炜2，徐俊3，沈伟4，陈俊2，刘文5，肖朝勇5，曹季祥5，徐德洋2，程欣欣2. 高清磁共振研究基底动脉粥样硬化狭窄重构模式在脑桥旁正中梗死中的应用[J]. 中国卒中杂志, 2013, 8(12): 953-958.

WANG Jiang-Bo*, JIANG Wei-Wei, XU Jun, SHEN Wei, CHEN Jun, LIU Wen, XIAO Chao-Yong, CAO Ji-Xiang, XU De-Yang, CHENG Xin-Xin.. Remodeling Pattern of Basilar Artery Atherosclerosis in Paramedian Pontine Infarction:A 3.0T High Resolution Magnetic Resonance Imaging Study[J]. Chinese Journal of Stroke, 2013, 8(12): 953-958.

参考文献

1 Fisher CM, Caplan LR. Basilar ar ter y branch

occlusion:a cause of pontine infarction[J]. Neurology,

1971, 21:900-905.

2 中华医学会神经病学分会. 脑血管疾病分类及诊断要

点[J]. 中华神经科杂志, 1996, 29:379-381.

3 Whitworth JA. 2003 World Health Organization

(WHO)/International Society of Hypertension (ISH)

statement on management of hypertension[J]. J

Hypertens, 2003, 21:1983-1992.

4 Alber ti KG, Zimmet PZ. Def inition, diagnosis

and classif ication of diabetes mellitus and its

complications. Part 1:diagnosis and classification

of diabetes mellitus provisional report of a WHO

consultation[J]. Diabet Med, 1998, 15:539-553.

5 National Cholesterol Education Program (NCEP)

Expert Panel on Detection, Evaluation, and Treatment

of High Blood Cholesterol in Adults (Adult Treatment

Panel Ⅲ). Third Report of the National Cholesterol

Educat ion Prog r am (NCEP) Expe r t Panel on

Detection, Evaluation, and Treatment of High Blood

Cholesterol in Adults (Adult Treatment Panel Ⅲ) final

report[J]. Circulation, 2002, 106:3143-3421.

6 Grundy SM, Brewer HJ, Cleeman JI, et al. Definition

of metabolic syndrome:Report of the National Heart,

Lung, and Blood Institute/American Heart Association

conference on scientific issues related to definition[J].

Circulation, 2004, 109:433-438.

7 Wang Y, Cui L, Ji X, et al. The China National Stroke

Registry for patients with acute cerebrovascular

events:design, rationale, and baseline patient

characteristics[J]. Int J Stroke, 2011, 6:355-361.

8 Ma N, Jiang WJ, Lou X, et al. Arterial remodeling

of advanced basilar atherosclerosis:a 3-tesla MRI

study[J]. Neurology, 2010, 75:253-258.

9 朱先进, 王春雪, 姜卫剑. 3.0T高分辨磁共振研究大脑

中动脉粥样硬化性狭窄重构模式[J]. 中国卒中杂志,

2013, 8:171-176.

10 Xu WH, Li ML, Gao S, et al. In vivo high-resolution

MR imaging of symptomatic and asymptomatic

middle cerebral artery atherosclerotic stenosis[J].

Atherosclerosis, 2010, 212:507-511.

11 Field TS, Benavente OR. Penetrating artery territory

pontine infarction[J]. Rev Neurol Dis, 2011, 8:30-38.

12 Gallego CJ, Erro AM. Basilar branch occlusion[J].

Curr Treat Options Cardiovasc Med, 2011, 13:247-260.

13 Bassetti C, Bogousslavsky J, Barth A, et al. Isolated

infarcts of the pons[J]. Neurology, 1996, 46:165-175.

14 Bodle JD, Feldmann E, Swartz RH, et al. Highresolution

magnetic resonance imaging:an emerging

tool for evaluating intracranial arterial disease[J].

Stroke, 2013, 44:287-292.

15 Klein IF, Lavallee PC, Schouman-Claeys E, et al.

High-resolution MRI identifies basilar artery plaques

in paramedian pontine infarct[J]. Neurology, 2005,

64:551-552.

16 Kim YS, Lim SH, Oh KW, et al. The advantage of

high-resolution MRI in evaluating basilar plaques:a

comparison study with MRA[J]. Atherosclerosis,

2012, 224:411-416.

17 Turan TN, Rumboldt Z, Brown TR. High-resolution

MRI of basilar atherosclerosis:three-dimensional

acquisition and FLAIR sequences[J]. Brain Behav,

2013, 3:1-3.

18 Chung GH, Kwak HS, Hwang SB, et al. High

resolution MR imaging in patients with symptomatic

middle cerebral artery stenosis[J]. Eur J Radiol, 2012,

81:4069-4074.

19 Ma N, Lou X, Zhao TQ, et al. Intraobserver and

interobserver variability for measuring the wall area

of the basilar artery at the level of the trigeminal

ganglion on high-resolution MR images[J]. AJNR Am

J Neuroradiol, 2011, 32:E29-E32.

20 Xu WH, Li ML, Gao S, et al. Plaque distribution

of stenotic middle cerebral artery and its clinical

relevance[J]. Stroke, 2011, 42:2957-2959.

21 Tatsumi S, Yamamoto T. An autopsied case of an

apparent pontine branch atheromatous disease[J]. Eur

Neurol, 2010, 63:184-185.

22 Klein IF, Lavallee PC, Mazighi M, et al. Basilar artery

atherosclerotic plaques in paramedian and lacunar

pontine infarctions:a high-resolution MRI study[J].

Stroke, 2010, 41:1405-1409.

23 Varnava AM, Mills PG, Davies MJ. Relationship

between coronary artery remodeling and plaque

vulnerability[J]. Circulation, 2002, 105:939-943.

24 Klein IF, Lavallee PC, Touboul PJ, et al. In vivo

middle cerebral artery plaque imaging by highresolution

MRI[J]. Neurology, 2006, 67:327-329.

25 Li ML, Xu WH, Song L, et al. Atherosclerosis of

middle cerebral artery:evaluation with high-resolution

MR imaging at 3T[J]. Atherosclerosis, 2009, 204:447-

452.

26 Nakamura M, Nishikawa H, Mukai S, et al. Impact of

coronary artery remodeling on clinical presentation

of coronary artery disease:an intravascular ultrasound

study[J]. J Am Coll Cardiol, 2001, 37:63-69.

27 Wexberg P, Gyongyosi M, Sperker W, et al. Preexisting

arterial remodeling is associated with inhospital

and late adverse cardiac events after coronary

interventions in patients with stable angina pectoris[J].

J Am Coll Cardiol, 2000, 36:1860-1869.

28 Jiang WJ, Yu W, Ma N, et al. High resolution MRI

guided endovascular intervention of basilar artery

disease[J]. J Neurointerv Surg, 2011, 3:375-378.

29 娄昕. 磁共振成像评估动脉粥样硬化斑块的重要影像

检查方法[J]. 中国卒中杂志, 2012, 7:835-838.

[1]	符鹏程, 曹黎明, 朱佳倩, 赵桂玉, 徐格林. 大动脉粥样硬化性缺血性卒中再灌注治疗的研究进展[J]. 中国卒中杂志, 2024, 19(9): 1004-1011.
[2]	中国卒中学会医疗质量管理与促进分会, 《中英文标准化动脉粥样硬化性脑血管病术语中国专家共识》编写组. 中英文标准化动脉粥样硬化性脑血管病术语中国专家共识 [J]. 中国卒中杂志, 2024, 19(8): 973-977.
[3]	李彦江, 刘彤晖, 田惠, 孙岩, 张勇. 药物涂层球囊与普通球囊血管成形术治疗症状性颅内动脉粥样硬化性狭窄的安全性和预后对比研究 [J]. 中国卒中杂志, 2024, 19(7): 803-808.
[4]	赵晨阳, 李进, 李东野, 乔会昱, 赵锡海, 周丹. 颅内动脉与颈动脉并存斑块分布特征对缺血性卒中复发风险的预测价值研究[J]. 中国卒中杂志, 2024, 19(6): 647-654.
[5]	王艳玲, 王雪梅. 普罗布考联合阿托伐他汀治疗多发脑血管狭窄合并主动脉弓溃疡斑块病例报道[J]. 中国卒中杂志, 2024, 19(2): 202-206.
[6]	逯青丽, 吴松笛. 视觉传导通路血液供应解剖概述[J]. 中国卒中杂志, 2024, 19(11): 1306-1312.
[7]	侯宇婷, 李通. 基于快速CYP2C19基因检测的急性基底动脉闭塞患者双联抗血小板治疗1例报道[J]. 中国卒中杂志, 2024, 19(10): 1125-1130.
[8]	王伊龙, 陈玮琪, 刘欣如, 王文志, 王永刚, 王婷婷, 王蓬莲, 刘改芬, 江滨, 许予明, 许玉园, 许杰, 孙冬玲, 孙海欣, 李子孝, 李姝雅, 杨沫, 杨晓萌, 杨营营, 周梦圆, 郑华光, 宗黎霞, 单舒乙, 赵璟妍, 茹小娟, 姜勇, 秦海强, 贾茜, 高远, 梅延亮, 曹勇, 盖思齐, 焦玉明, 谢雪微, 潘岳松, 中国卒中学会中国脑血管病临床管理指南撰写工作委员会. 中国脑血管病临床管理指南（第2版）（节选）——第3章脑血管病高危人群管理[J]. 中国卒中杂志, 2023, 18(8): 898-909.
[9]	平曼, 潘培炎, 米东华. 银杏叶提取物注射液治疗后循环缺血性眩晕疗效的meta分析[J]. 中国卒中杂志, 2023, 18(12): 1418-1428.
[10]	司倩倩, 程安琪, 范晓媛, 张晓倩, 李明利, 冯逢, 刘彩燕, 徐蔚海. 症状性颅内动脉粥样硬化性狭窄患者的认知功能及脑结构改变[J]. 中国卒中杂志, 2023, 18(11): 1228-1237.
[11]	梁佳, 康慧斌, 李葆青, 隋滨滨. 青年颅内动脉狭窄患者高分辨率磁共振血管壁成像的影像特征[J]. 中国卒中杂志, 2023, 18(11): 1255-1261.
[12]	吴敌, 廖晓凌, 潘岳松, 陈绪珠, 王伊龙, 赵性泉. 自发性椎动脉及基底动脉夹层相关脑梗死病灶分布特征与受累血管节段间的关系[J]. 中国卒中杂志, 2023, 18(10): 1121-1128.
[13]	王璐, 王健. 穿支动脉粥样硬化病患者早期神经功能恶化的研究进展[J]. 中国卒中杂志, 2023, 18(10): 1191-1195.
[14]	中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2023[J]. 中国卒中杂志, 2023, 18(06): 684-711.
[15]	陈露露, 汪敬业. 毛霉菌性鼻窦炎侵袭椎基底动脉致反复脑梗死1例报道[J]. 中国卒中杂志, 2023, 18(05): 583-586.