脑梗死急性期MRI表现与发展为血管性痴呆的关系

目的 探讨脑梗死急性期患者的MRI表现与发展为血管性痴呆(VD)的关系.方法 对卒中半年以上的患者,根据简易精神状态检查量表(MMSE)、临床痴呆评定量表(CDR)评分分为VD组及脑卒中后无痴呆(SWD)组,并回顾性分析两组在卒中急性期的MRI资料.结果 VD组中额叶皮质下、颞叶皮质下、内囊前肢、内囊膝部、尾状核及丘脑梗死的发生率明显高于SWD组(P<0.05～0.01);梗死灶≥3个部位的患者显著多于SWD组(P<0.05);3级脑白质疏松(LA)发生率(35.0%)明显高于SWD组(10.0%)(P<0.05). VD组放射冠及基底节的LA发生率明显高于SWD组(P<0.05).VD组与SWD组间脑萎缩的线性指标海马钩回间距及侧脑室体部宽度指数的差异有统计学意义(P<0.05～0.01).结论 额叶及颞叶皮质下、内囊前肢及膝部、尾状核和丘脑梗死者,且梗死灶≥3个,并出现3级LA,放射冠、基底节的LA,以及海马钩回间距、侧脑室体部宽度指数可作为发展为VD的预测指标.

Relationship between MRI features of acute cerebral infarction and developing vascular dementia

Objective To study the relationship between the MRI features of acute cerebral infarction (ACI) and developing vascular dementia (VD). Methods The patients who had ACI history more than 6 months were divided into vascular dementia group and no vascular dementia group by MMSE and CDR evaluations. The MRI data of acute stoke of the two groups were reviewed and analyzed retrospectively. Results In VD group the happenings of infarction at subcortex of lobus frontalis, subcortex of lobus temporalis, anterior capsula interna, knee of capsula interna, nucleus caudatus and thalamus were more than those in no vascular dementia group (P<0.05~0.01). Infarctions involved more than 3 positions in VD group were also more than that in no vascular dementia group (P<0.05). Degree 3 of LA was 35.0% in VD group and 10.0% in no vascular dementia group, there was a significant difference between the two groups (P<0.05). The incidence rates of LA in corona radiata and basal ganglia in ACI group were significantly higher than those in no vascular dementia group (P<0.05). The MRI linearity index of brain atrophy (hippocampi interuncal distance and ventricular index) between VD group and no vascular group was significantly different ( P<0.05~0.01). Conclusions The infarctions in subcortex of lobus frontalis, subcortex of lobus temporalis, anterior capsula interna, knee of capsula interna, nucleus caudatus and thalamus, at the same time infarctions involved more than 3 positions, degree 3 of LA, LA in corona radiata and basal ganglia, hippocampi interuncal distance and ventricular index may be used as predictable index of developing VD in ACI patients.