症状性基底动脉粥样硬化病人斑块特征与血管几何形态的HR-MRI研究

目的 探讨后循环症状性基底动脉粥样硬化病人椎-基底动脉几何形态、斑块特征与梗死的关系。方法 回顾性纳入症状性基底动脉（BA）粥样硬化病人42例,男30例,女12例,平均年龄（63.5±10.8）岁。根据DWI上是否存在BA供血区急性梗死将病人分为梗死组（22例）和无梗死组（20例）,并根据椎动脉优势及BA构型再分组,利用三维MR血管成像（3D-MRA）识别BA及椎动脉曲线类型,于高分辨MRI（HR-MRI）上确定斑块定量（斑块负荷、斑块面积等）及定性（斑块分布、强化程度等）特征,采用Mann-Whitney U检验或Student t检验比较组间BA-中角/BA-VA角度及斑块定量指标差异,采用Fisher精确概率检验比较组间临床计量资料及斑块定性指标差异。结果 与梗死组相比,无梗死组的斑块多见于腹侧（P=0.030）。与无梗死组相比,梗死组的BA-中角及BA-VA角更大（P<0.05）,BA斑块面积、斑块负荷更大（P<0.05）,BA斑块强化比例更高（P=0.019）。2组间年龄、性别、高血压、糖尿病、高血脂等临床资料差异均无统计学意义（均P>0.05）。VA优势组的BA斑块强化比例更高（P=0.033）,BA弯曲组的斑块更易位于侧壁,且斑块负荷更大（均P<0.05）。结论 椎-基底动脉的几何形态影响斑块分布及强化程度,并可能在一定程度上成为缺血性梗死发生的潜在因素。

HR-MRI study of plaque characteristics and vascular geometry in patients with symptomatic basal atherosclerosis

Objective To investigate the geometry of vertebral-basilar artery(BA)and plaque characteristics,and their relationships with infarction in patients with posterior circulation symptomatic basilar atherosclerosis.Methods Retrospectively analyzed 42 patients with symptomatic basilar atherosclerosis,including 30 males and 12 females,average age 63.5±10.8 years.According to whether there was acute infarction in the blood supply territory of BA on DWI,patients were divided into infarct group(22 cases)and non-infarct group(20 cases).The two groups were further divided into subgroups based on the vertebral artery dominance and basilar artery configuration.Three-dimensional MR angiography(3D-MRA)was used to identify the curve types of basilar artery and vertebral artery.The characteristics of plaque quantification(plaque burden,plaque area,etc.)and characterization(plaque distribution,enhancement,etc.)were determined on HR-MRI.Mann-Whitney U test or Student t test was used to compare the differences in(BA-middle angle)/(BA-VA angle)and plaque quantitative index between the groups.Fisher’s exact test was used to compare differences in clinical measurement data and plaque qualitative measurements between the groups.Result The plaques were more common on the ventral side(P=0.030)in the non-infarct group than in the infarct group.Compared with the non-infarct group,the BA-medium angle and BA-VA angle of the infarct group were larger(P<0.05),the area and plaque load of BA were larger(P<0.05),and the basilar artery proportion of plaque enhancement was higher(P=0.019).There was no significant difference in clinical data such as age,gender,hypertension,diabetes,and hyperlipidemia between the groups(P>0.05).The proportion of enhanced basilar artery plaque in the VA predominant group more higher(P=0.033),and the plaque in the BA bending group was more easily located on the side wall and the plaque load was higher compared to the non-bending group(all P<0.05).Conclusion The geometry of the vertebrobasilar artery affects the plaque distribution and degree of enhancement,indicative of a potential factor for ischemic infarction.