基底动脉粥样硬化性梗死的分类与血管形态学异同的探讨

目的 应用高分辨率磁共振(HR-MRI)管壁成像技术研究基底动脉粥样硬化性梗死两种类型——穿支闭塞型病变(BOD)和非穿支闭塞型病变(non-BOD)的血管重构与斑块特征.方法 将32例症状性基底动脉狭窄患者分为BOD 18例,non-BOD 14例.应用3.0T HR-MRI对基底动脉进行管壁增强扫描,然后使用CMRtools软件对血管狭窄最严重的层面的管壁及斑块面积等参数进行测量,研究血管的重构和斑块特征.结果 HR-MRI管壁成像结果显示,non-BOD组血管狭窄程度较BOD组更明显[(68.9％±19.1)％ vs (43.8％±18.8)％,P=0.017].正性重构更常见于non-BOD (57.2％ vs16.7％,P=0.036).BOD组管壁面积指数小于non-BOD组(P＜0.001).两组血管强化均以偏心性为主,两组斑块强化比例差异无统计学意义(P=0.196),但BOD组强化程度小于non-BOD组[(39.9±23.2)％ vs (65.3±21.1)％,P=0.004].结论 基底动脉BOD梗死和non-BOD型梗死在血管重构和斑块性质方面的特征各不相同.

Vascular pathophysiologic characteristics of different types of basilar atherosclerotic infarction

Objective To use high-resolution magnetic resonance imaging (HR-MRI) for studying the vascular remodeling and plaque characteristics of two types of basilar atherosclerotic infarction:branch occlusive disease (BOD) and non-BOD. Methods Thirty-two patients with symptomatic basilar artery stenosis were divided into BOD and non-BOD groups, with 18 patients in BOD group and 14 in non-BOD group. All the patients received 3.0T HR-MRI enhancement scanning for the basilar artery wall. The wall thickness and plaque area of steno-occlusive basilar artery at the maximal stenosis were measured and analyzed, so as to assess the vascular remodeling and plaque characteristics. Results HR-MRI scanning showed that the stenosis of non-BOD group was more obvious than that of BOD group ([68.9±19.1]% vs[43.8±18.8]%, P=0.017). Compared with BOD group, positive remodeling was more frequently observed in non-BOD (57.2% vs 16.7%, P=0.036). The wall area index of BOD group was also significantly lower than that of non-BOD group (P<0.001). Eccentric enhancement was the main form for the two types of basilar atherosclerotic infarction in study, and the plaque enhancements were not significantly different between BOD and non-BOD groups (P=0.196); however, the enhancement degree of BOD group was significantly milder than that of the non-BOD group ([39.9±23.2]% vs[65.3±21.1]%, P=0.004). Conclusion BOD and non-BOD have different vascular remodelings and plaque characteristics.