烟雾病和动脉粥样硬化烟雾综合征成年患者的HR-MRI管壁成像特征比较

目的 回顾性分析烟雾病(MMD)和动脉粥样硬化烟雾综合征(AS-MMS)成年患者大脑中动脉(MCA)高分辨率磁共振(HR-MRI)管壁成像,探讨HR-MRI在MMD诊断中的价值.方法 选取第二军医大学长海医院临床确诊的MMD和AS-MMS成年患者各24例,对比分析两组患者的年龄及危险因素(发病形式、糖尿病、高血脂、高血压、既往卒中史).采用3.0T HR-MRI对各组患者大脑中动脉(MCA)行管壁增强扫描.分析两组患者MCA的血管内径和外径、管壁厚度、管壁信号强度、增强效应和MCA附近微小血管结构及重构指数等特征.采用ROC曲线分析MCA外径对MMD和AS-MMS的鉴别诊断价值.结果 MMD组和AS-MMS组患者的年龄及危险因素差异均有统计学意义(P＜0.05).MMD组患者的MCA外径较AS-MMS组减小[(2.70±0.44) mm vs (3.31±0.54) mm,P＜0.05],MCA管壁厚度增厚[(1.99±0.32) mm vs(1.39±0.57) mm,P＜0.05].AS-MMS组患者发生MCA管壁局灶性信号增强现象较MMD组更常见(50.00％ vs 33.33％,P＜0.05).与AS-MMS组比较,MMD组患者MCA多为阴性重构(79.17％ vs 25.00％,P＜0.05),平均重构指数降低(0.86±0.12 vs 1.05±0.21,P＜0.05),且MCA附近微小血管结构发生率升高(83.33％ vs 24.17％,P＜0.05).ROC曲线显示以3.13 mm为MCA外径界限值时,鉴别诊断MMD和AS-MMS的敏感度为90.7％,特异度为64.0％.结论 HR-MRI对MMD和AS-MMS的鉴别有重要意义.MMD的MCA管壁皱缩,多呈阴性重构,血管外径常＜3.13 mm,呈同心圆增厚,增强无强化或呈同心圆强化,且MCA附近更常见微小血管结构.

HR-MRI wall imaging study of Moyamoya disease and atherosclerotic Moyamoya syndrome in adult patients

Objective To analyze the high-resolution magnetic resonance imaging (HR-MRI) findings of middle cerebral artery (MCA) vessel wall for Moyamoya disease (MMD) and atherosclerotic Moyamoya syndrome (AS-MMS), and to explore the diagnostic value of HR-MRI for MMD. Methods We selected 24 MMD patients (MMD group) and 24 AS-MMS patients (AS-MMD group) from Changhai Hospital.HR-MRI comparison was made for the difference between the two groups concerning the ages and risk factors, including episode style, history of diabetes, hyperlipaemia, hypertension and stroke. 3.0T HR-MRI enhanced scanning was performed for MCA vessel wall changes in all patients.Then the inner and outer diameters of MCA, wall thickness, signal intensity of vessel wall, enhancement effect, microvascular adjacent to MCA and its remodeling index (RI) were analyzed. The outer diameters of two groups were analyzed by the receiver operating characteristic (ROC) curve. Results We found that ages and risk factors were significantly different between the MMD and AS-MMS groups (P<0.05). The MCA outer diameter was significantly smaller in MMD group than that in the AS-MMS group ([2.70±0.44] mm vs[3.31±0.54] mm, P<0.05), but the wall thickness was significantly thicker than that in the AS-MMS group ([1.99±0.32] mm vs[1.39±0.57] mm,P<0.05).The focal enhancement of MCA arterial wall in AS-MMS group was more commonly seen than that in MMD group (50.00% vs 33.33%, P<0.05). Compared with AS-MMS group, the RI in MMD group was mostly negative remodeling (79.17% vs 25.00%, P<0.05), with the average RI significantly decreased ([0.86±0.12] vs [1.05±0.21], P<0.05) and the occlusion incidence of microvascular adjacent significantly increased (83.33% vs 24.17%, P<0.05). ROC curve showed when the threshold value of MCA outer diameter was 3.13 mm, the differential diagnosis had a 90.7% sensitivity and a 64.0% specificity. Conclusion HR-MRI has an important value for differential diagnosis of MMD and AS-MMS.The arterial wall of MCA in MMD patients undergoes shrinkage and negative remodeling. The outer diameter is often less than 3.13 mm with concentric stenosis, and the arterial wall has no enhancement or concentric enhancement, with microvascular adjacent to MCA more commonly seen in MMD group.