高分辨率磁共振对大脑中动脉斑块与梗死灶类型关系的研究

doi:10.3969/j.issn.1673-5765.2017.12.004

摘要/Abstract

摘要：

目的本研究主要应用高分辨率磁共振成像（high-resolution magnetic resonance imaging，HRMRI）探索大脑中动脉（middle cerebral artery，MCA）粥样硬化所致狭窄与梗死灶分布类型的相关性，并进一步探索不同脑梗死类型与斑块性质、重塑率及患者发生卒中的可能机制。方法回顾性分析2012-2016年于南京鼓楼医院就诊的14 d内发生MCA供血区缺血性卒中并进行 HRMRI扫描的患者临床资料。在弥散加权成像（diffusion weighted imaging，DWI）上将梗死类型分为穿支动脉梗死（perforating artery infarct，PAI）、皮质支供血区梗死（pial infarct，PI）、分水岭梗死（border zone infarct，BZI）和混合型梗死（PAI+PI，PAI+BZI，PI+BZI，PAI+PI+BZI）。在矢状位HRMRI上测量MCA M1段狭窄率及重构率，并收集斑块位置、长度、厚度等形态学指标。正性重构＞1.05，负性重构＜0.95。将PAI、PI、BZI的患者分入单型梗死组，将PAI+PI、PAI+BZI、PI+BZI、PAI+PI+BZI的患者归入混合型梗死组。结果共纳入51例MCA狭窄程度≤50%的患者，其中单型组32例，混合组19例。单型组中，PAI 2 2 例（68.8%），PI 6例（18.7%），BZI 4例（12.5%），正性重构22例（68.8%）。混合组中PAI+BZI 7 例（36.8%），PAI+PI 2例（10.6%），PI+BZI 5例（26.3%），PAI+PI+BZI 5例（26.3%），正性重构17例（89.5%）。混合型组的狭窄程度较单型组重（P =0.01），斑块厚度较单型组大（P =0.001），比较差异有统计学意义。结论不同程度的MCA狭窄，其梗死灶分布有所不同，单型梗死主要为PAI，混合型梗死主要以 PAI+BZI多见。同时HRMRI发现对于轻型MCA狭窄的患者，血管的狭窄程度和斑块厚度增加可能与混合型梗死有关。

文章导读： 高分辨率磁共振对于大脑中动脉粥样硬化所致狭窄（≤50%）有很好的帮助，可预测卒中的机制，为治疗和预防提供方向。

关键词: 高分辨率磁共振; 大脑中动脉狭窄; 脑梗死类型; 斑块

Abstract:

to analyze the relationship between the stenosis of the middle cerebral artery (MCA) atherosclerosis and the type of infarction distribution, and further explored the different types of cerebral infarction and plaque nature, remodeling rate and the possible mechanism of stroke in patients. Methods The clinical data of patients with MCA blood supplied ischemic stroke and highresolution magnetic resonance imaging within 14 days of treatment from Nanjing Drum Tower Hospital in 2012-2016 were analyzed retrospectively. Perforating artery infarct (PAI), pial infarct (PI), border zone infarct (BZI) and mixed infarcts (PAI+PI, PAI+BZI, PI+BZI, PAI+PI+BZI) were performed on diffusion weighted imaging (DWI). The stenosis rate and remodeling rate of MCA M1 were measured on sagittal HRMRI, and the morphological indexes such as position, length and thickness were collected. The reconstruction rate of positive remodeling (PR) was more than 1.05 and negative remodeling (NR) was low than 0.95. Patients with PAI, PI, and BZI were divided into single type infarct group. Patients with PAI+PI, PAI+BZI, PI+BZ, PAI+PI+BZI were assigned to mixed type infarct group. Results A total of 51 patients with MCA stenosis ≤50% were included in the study. Among which, 32 cases were in single type infarct group and 19 cases were in mixed type infarct group. There were 22 cases of patients with PAI (68.8%), 6 patients with PI (18.7%) and 4 with BZI (12.5%), 22 patients with PR (68.8%) in single. In the mixed type infarct group, 7 were PAI+BZI (36.8%), 2 were PAI+PI (10.6%), 5 were PI+BZI (26.3%) 5 were PAI+PI+BZI (26.3%), and 17 were PR (89.5%). The degree of stenosis in the mixed type infarct group was more severe (P =0.01) and the plaque thickness was larger (P =0.001) than single type infarct group, which had significant difference. Conclusion Different degrees of middle cerebral artery stenosis had different distribution of infarction. In single type infarct group, the cerebral infarction pattern was mainly PAI, while PAI+BZI was most common in mixed. At the same time, HRMRI found that increased stenosis and plaque thickness might be associated with mixed infarction for patients with mild MCA stenosis.

Key words: High-resolution magnetic resonance imaging; Middle cerebral artery stenosis;Type of cerebral infarction; Plaque

徐曼曼，徐运，周飞，张鑫，张冰，王一峰，李敬伟. 高分辨率磁共振对大脑中动脉斑块与梗死灶类型关系的研究[J]. 中国卒中杂志, 2017, 12(12): 1086-1092.

XU Man-Man, XU Yun, ZHOU Fei, ZHANG Xin, ZHANG Bing,WANG Yi-Feng, LI Jing-Wei. Study on the Relationship between Middle Cerebral Artery Plaque and Infarct Type by High-resolution Magnetic Resonance Imaging[J]. Chinese Journal of Stroke, 2017, 12(12): 1086-1092.

参考文献

[1] SWARTZ R H，BHUTA S S，FARB R I，et al.

Intracranial arterial wall imaging using highresolution

3-tesla contrast-enhanced MRI[J].

Neurology，2009，72（7）：627-634.

[2] ARENILLAS J F. Intracranial atherosclerosis：

current concepts[J/OL]. Stroke，2011，42（1 Suppl）：

S20-S23. DOI: 10.1161/STROKEAHA.110.597278.

http://stroke.ahajournals.org/content/42/1_suppl_1/

S20.

[3] KASNER S E，CHIMOWITZ M I，LYNN M J，et

al. Predictors of ischemic stroke in the territory

of a symptomatic intracranial arterial stenosis[J].

Circulation，2006，113（4）：555-563.

[4] WANG Y，ZHAO X，LIU L，et al. Prevalence and

outcomes of symptomatic intracranial large artery

stenoses and occlusions in China：the Chinese

Intracranial Atherosclerosis（CICAS）Study[J].

Stroke，2014，45（3）：663-669.

[5] KIM Y S，LIM S H，OH K W，et al. The advantage

of high-resolution MRI in evaluating basilar plaques：

a comparison study with MRA[J]. Atherosclerosis，

2012，224（2）：411-416.

[6] UNDERHILL H R，YARNYKH V L，

HATSUKAMI T S，et al. Carotid plaque morphology

and composition：initial comparison between 1. 5-

and 3. 0-T magnetic field strengths[J]. Radiology，

2008，248（2）：550-560.

[7] YANG W Q，HUANG B，LIU X T，et al.

Reproducibility of high-resolution MRI for the

middle cerebral artery plaque at 3T[J/OL]. Eur

J Radiol，2014，83（1）：e49-e55. DOI: 10.1016/

j.ejrad.2013.10.003. http://dx.doi.org/10.1016/

j.ejrad.2013.10.003.

[8] MA N，JIANG W J，LOU X，et al. Arterial

remodeling of advanced basilar atherosclerosis：a

3-tesla MRI study[J]. Neurology，2010，75（3）：253-

258.

[9] XU W H，LI M L，GAO S，et al. Plaque distribution

of stenotic middle cerebral artery and its clinical

relevance[J]. Stroke，2011，42（10）：2957-2959.

[10] LI M L，XU W H，SONG L，et al. Atherosclerosis

of middle cerebral artery：evaluation with high1092

Chin J Stroke, Dec 2017, Vol 12, No.12

resolution MR imaging at 3T[J]. Atherosclerosis，

2009，204（2）：447-452.

[11] LEE D K，KIM J S，KWON S U，et al. Lesion

patterns and stroke mechanism in atherosclerotic

middle cerebral artery disease：early diffusionweighted

imaging study[J]. Stroke，2005，36（12）：

2583-2588.

[12] ISAKA Y，NAGANO K，NARITA M，et al. High

signal intensity on T2-weighted magnetic resonance

imaging and cerebral hemodynamic reserve in

carotid occlusive disease[J]. Stroke，1997，28（2）：

354-357.

[13] CHUNG G H，KWAK H S，HWANG S B，et

al. High resolution MR imaging in patients with

symptomatic middle cerebral artery stenosis[J]. Eur

J Radiol，2012，81（12）：4069-4074.

[14] SACCO R L，BENJAMIN E J，BRODERICK J

P，et al. American Heart Association Prevention

Conference. Ⅳ. Prevention and Rehabilitation of

Stroke. Risk factors[J]. Stroke，1997，28（7）：1507-

1517.

[15] BANG O Y，HEO J H，KIM J Y，et al. Middle

cerebral artery stenosis is a major clinical

determinant in striatocapsular small，deep

infarction[J]. Arch Neurol，2002，59（2）：259-263.

[16] YONG S W，BANG O Y，LEE P H，et al. Internal

and cortical border-zone infarction：clinical and

diffusion-weighted imaging features[J]. Stroke，

2006，37（3）：841-846.

[17] XU W H，LI M L，GAO S，et al. In vivo highresolution

MR imaging of symptomatic and

asymptomatic middle cerebral artery atherosclerotic

stenosis[J]. Atherosclerosis，2010，212（2）：507-511.

[18] SCHOENHAGEN P，ZIADA K M，KAPADIA S

R，et al. Extent and direction of arterial remodeling

in stable versus unstable coronary syndromes：an

intravascular ultrasound study[J]. Circulation，2000，

101（6）：598-603.

[19] ZHU X J，DU B，LOU X，et al. Morphologic

characteristics of atherosclerotic middle cerebral

arteries on 3T high-resolution MRI[J]. AJNR Am J

Neuroradiol，2013，34（9）：1717-1722.

[20] 李文君，刘俊艳. 不同机制症状性颅内动脉粥样硬

化性疾病的高分辨率磁共振特征[J]. 中国卒中杂志，

2016，11（4）：262-268.

[21] WASSERMAN B A，WITYK R J，TROUT H H

3RD，et al. Low-grade carotid stenosis：looking

beyond the lumen with MRI[J]. Stroke，2005，36

（11）：2504-2513.

[22] YUAN C，MITSUMORI L M，BEACH K W，et

al. Carotid atherosclerotic plaque：noninvasive MR

characterization and identification of vulnerable

lesions[J]. Radiology，2001，221（2）：285-299.