颈动脉粥样硬化斑块与脑梗死关系的高分辨磁共振研究

目的探讨高分辨磁共振(MRI)对颈动脉粥样硬化斑块与脑梗死关系的评估价值。方法选取驻马店市精神病医院2014-01—2016-01收治的32例经高分辨MRI检查证实的脑梗死患者为试验组,以同期我院体检的行MRI扫描的25例无脑梗死患者作对照(对照组),采用三维时间飞跃法(3D-TOF)、T1加权(T1WI)、T2加权(T2WI)及增强颈部血管成像等扫描序列,分析颈动脉斑块的成分、分型及其与脑梗死的关系。结果试验组有颈动脉粥样硬化斑块者30例(93.75%),无颈动脉粥样硬化斑块者2例(6.25%);对照组有颈动脉粥样硬化斑块者6例(24.00%),无颈动脉粥样硬化斑块者19例(76.00%);试验组颈动脉粥样硬化斑块的发生率明显高于对照组(P0.01)。试验组共发现60块颈动脉粥样硬化斑块,其中Ⅰ~Ⅱ型7块(11.67%),Ⅲ型8块(13.33%),Ⅳ~Ⅴ型19块(31.67%),Ⅵ型21块(35.00%),Ⅶ型2块(3.33%),Ⅷ型3块(5.00%);对照组共发现14块颈动脉粥样硬化斑块,以稳定性斑块为主,Ⅰ~Ⅱ型13块(92.86%),Ⅳ型1块(7.14%)。2组颈动脉不稳定斑块发生率比较差异有统计学意义(P0.05)。脑梗死患者颈总动脉、分叉处及颈内动脉3个部位的粥样硬化斑块分布情况差异无统计学意义(P0.05)。结论高分辨MRI可清晰显示颈动脉粥样斑块的内部成分,且颈动脉粥样硬化斑块与脑梗死的发生有密切的相关性,高分辨MRI可对脑梗死的发生风险作出预测,为临床防治脑梗死及疗效评价提供重要的影像学依据。

Study of high resolution magnetic resonance imaging on the relationship between carotid atherosclerotic plaque and cerebral infarction

Objective To investigate the value of high resolution magnetic resonance imaging for the relationship between carotid atherosclerotic plaque and cerebral infarction.Methods Thitry-two cases of cerebral infarction patients confirmed by high resolution MRI examination from Jan.2014 to Jan.2016 in the Mental Hospital of Zhumadian were selected as the experimental group.At the same time,25 patients without cerebral infarction underwent physical examination by MRI scan in our hospital were as control group.Carotid plaque composition,classification and its relationship with cerebral infarction were analyzed by 3D time-of-flight (3D-TOF),T1 weighted imaging (T1WI),T2 weighted imaging (T2WI) and enhanced neck angiography.Results Thirty cases (93.75％) had carotid atherosclerosis plaques and 2 cases (6.25 ％) without carotid atherosclerosis plaques in the experimental group.Six cases (24 ％) had carotid atherosclerosis plaque,19 cases (76 ％) without carotid artery atherosclerotic plaque in the control group.The occurrence of carotid atherosclerotic plaque in the experimental group was significantly higher than that of the control group (P＜0.01).Sixty carotid atherosclerotic plaques were found in the experimental group,in which 7 (11.67 ％) of Ⅰ-Ⅱ type,8 (13.33％) of Ⅲ type,19 (31.67％) of Ⅳ-Ⅴ type,21 (35％) of Ⅵ type,2 (3.33％) of Ⅶ type,3 (5％) of Ⅷ type;14 carotid atherosclerotic plaques were found in the control group and were mainly stable plaques,in which 13 (92.86 ％) of Ⅰ-Ⅱ type,1 (7.14％) of Ⅲ type.The incidence of unstable carotid plaque had significant difference in the two groups (P＜0.05).The distribution of atherosclerotic plaque of cerebral infarction patients among cephalic artery,the bifurcation of carotid artery and internal carotid had no significant differences (P＞0.05).Conclusion High resolution MRI can clearly display the internal components of carotid atherosclerotic plaques.Carotid atherosclerotic plaques are closely related to cerebral infarction,and high resolution MRI can predict the risk of cerebral infarction and provide important imaging evidence for clinical prevention and treatment and evaluation of therapeutic efficiency on cerebral infarction.