高分辨率磁共振评价单侧大脑中动脉闭塞管腔形态特征及脑梗死类型

目的利用高分辨率磁共振(high-resolution magnetic resonance imaging,HR-MRI)评价单侧大脑中动脉M1段闭塞两种不同的管腔形态特征及对应脑梗死类型的差异。材料与方法回顾性分析因缺血性脑卒中住院诊断为单侧大脑中动脉M1段闭塞患者资料,所有患者均在发病1周内行HR-MRI及头颅扩散加权成像(diffusion weighted imaging,DWI)检查,观察大脑中动脉M1段闭塞管腔形态特征及头颅DWI上脑梗死类型。依照HR-MRI上闭塞管腔的形态学特征将患者分为斑块形成组与非斑块形成组;DWI上脑梗死类型分为单发脑梗死、多发脑梗死、无脑梗死灶。结果 44例患者纳入分析,斑块形成组30例,非斑块形成组14例。斑块形成组闭塞位置位于近端16例,远端14例,非斑块形成组闭塞部位为近端13例,远端1例,两组闭塞部位差别有统计学意义(P=0.025,χ~2=4.99),非斑块形成组闭塞部位多为M1段近端。斑块形成组与非斑块形成组单发性脑梗死分别为11例和5例,多发性梗死分别为15例和2例,无梗死灶分别为4例和7例,两组脑梗死类型差别有统计学意义(P=0.016,χ~2=8.29),斑块形成组脑梗死类型多为多发性脑梗死,而非斑块组多为单个脑梗死或无梗死灶。结论高分辨MRI对大脑中动脉闭塞管腔管壁形态特征评价具有重要价值,闭塞管腔内是否有斑块与主干周围有无侧支形成可能是大脑中动脉闭塞后不同脑梗死类型差异的一个重要原因。

Evaluation of the morphological characteristics and infarction pattern of unilateral middle cerebral artery occlusion using high resolution magnetic resonance imaging

AbstractObjective:To evaluate the two different morphological characteristics and corresponding infarction pattern of unilateral middle cerebral artery occlusion using high resolution magnetic resonance imaging (HR-MRI).Materials and Methods:The data of patients with ischemic stroke in hospital diagnosed as unilateral middle cerebral artery M1 segment occlusion was retrospectively analyzed. HR-MRI and DWI were performed in all patients within 1 week of symptom onset. To observe the morphological characteristics of occlusion of the middle cerebral artery (M1) segment and the cerebral infarction type on the cranial DWI. The patients were divided into plaque formation group and non plaque formation group according to the morphological characteristics of HR-MRI. DWI lesion patterns were classiifed as single cerebral infarction, multiple cerebral infarction, and no cerebral infarction (TIA).Results:Forty-four patients were included in the analysis, 30 cases of plaque formation group, while 14 cases of non plaque formation group. There were 16 cases in plaque formation group with the location of occlusion in the proximal of M1 segment, 14 cases in the distal and non plaque formation group in the proximal 13 cases,while 1 case in the distal, there was signiifcant difference between the two groups (P=0.025,χ2=4.99), the location of occlusion of plaque formation group was mostly in the proximal. Plaque formation group and non plaque formation group of single cerebral infarction in 11 cases and 5 cases respectively, multiple infarction in 15 cases and 2 cases, no infarction lesion in 4 cases and 7 cases, there were signiifcant differences in the types of cerebral infarction between the two groups (P=0.016,χ2=8.29). Infarction pattern in plaque formation was mostly multiple cerebral infarction, but the non plaque group was single cerebral infarction or no cerebral infarction (TIA).Conclusion:HR-MRI has important value in evaluating the morphological characteristics of the lumen of middle cerebral artery occlusion. Whether there is plaque in the lumen of the occlusion or collateral formation around the trunk may be one of the important reasons for different types of cerebral infarction after middle cerebral artery occlusion.