粥样硬化性大脑中动脉狭窄或闭塞患者病灶分布与卒中机制的MRI研究

目的运用MRI成像方法探讨大脑中动脉狭窄或闭塞患者的梗死灶分布与卒中机制之间的联系。方法回顾性分析2014年1月至2016年5月我院住院的138例单侧大脑中动脉主干狭窄伴供血区域急性脑梗死患者的临床资料及头颅MR检查(包括T_1WI、T_2WI、DWI、MRA)。依据DWI上高信号病灶的分布部位将梗死灶分为皮层梗死、深穿支梗死和交界区梗死;依据DWI上高信号病灶数目分为单发梗死(MCA供血区的单一梗死灶)、多发梗死(MCA供血区两个及两个以上的不连续病灶);依据MRA将MCA主干狭窄程度分为中度狭窄、重度狭窄、闭塞。比较不同狭窄程度之间病灶的数目与梗死分布之间的差异。结果 138例图像用于分析,其中单发梗死者61例、多发梗死者77例;大脑中动脉中度狭窄组54例、重度狭窄组58例、闭塞组26例。中度狭窄组以单发的深穿支梗死为最常见的分布类型(χ~2=13.197;P0.001)。重度狭窄组以多发的皮层梗死+深穿支梗死+交界区梗死多见(χ~2=5.561;P=0.018)。闭塞组病灶分布在单发与多发之间的差异无统计学意义(χ~2=0.049;P=0.842),但大面积梗死较其他组多(χ~2=24.745;P0.001)。结论粥样硬化性大脑中动脉狭窄或闭塞患者的病灶分布与梗死机制存在一定的关系。

Study on Lesion Patterns and Mechanism in Atherosclerotic Middle Cerebral Artery Stenosis or Occlusion

Objective To investigate the association between lesion patterns and infarction mechanism in acute infarction patients who had atherosclerotic middle cerebral artery(MCA) stenosis or occlusion.Methods We retrospectively reviewed 138 cases acute infarction in unilateral MCA areas with MCA stem stenosis or occlusion from January 2014 to May 2016, including clinical data and head MR examination(T1WI, T2WI, DWI, MRA). According to distribution of hyperintense on DWI, lesion patterns were divided into perforating artery infarction(PAI), pial infarction(PI), border-zone infarction(BZI). Single infarction had one lesion, multiple infarctions had two or more lesion. According to MRA, the degree of MCA stenosis was divided into moderate, severe, occlusive. Then, we compared the difference between single infarction and multiple infarctions, different stenotic degree.Results 61 cases had single lesion, 77 cases had multiple lesions. Moderate stenosis group had 54 cases, single PAI was the most common infarction type(χ2=13.197, P<0.001). Severe stenosis group had 58 cases, multiple PI+PAI+BZIwas the most common infarction type(χ2=5.561, P=0.018). Occlusion group had 26 cases, there was no statistical differernce between single lesion and multiple lesions(χ2=0.049, P=0.842), but it has many large area infarction cases(χ2=24.745, P<0.001).Conclusion Different infarction patterns may indicate different mechanism in patients with atherosclerotic middle cerabral artery stenosis or occlusion.