116例大脑中动脉病变患者脑梗死类型分布和脑灌注异常分析

目的 应用神经影像检查,分析大脑中动脉闭塞性疾病(MCAOD)患者梗死类型分布和脑灌注异常. 方法 对经CT血管造影(CTA)证实的116例MCAOD患者的CT平扫、CT灌注成像(CTP)和CTA的影像资料进行回顾性分析,确定其脑梗死类型分布和脑灌注改变. 结果 116例患者中,CTA共检出133条大脑中动脉(MCA)狭窄或闭塞,其中单侧者99例,双侧者17例.其中MCA闭塞25条,重度狭窄39条,中、轻度狭窄69条.CT或MRI显示腔隙性脑梗死(LIS)45例,各型分水岭脑梗死(CWSI)38例,流域性脑梗死26例,纹状体内囊梗死(SCI)10例,未检出梗死病灶14例.CTP显示MCA供血区内脑血流灌注异常96例,其中58例有MCA供血区的大范围血流灌注减低.未检出血流灌注异常者37例. 结论 由于MCA狭窄的部位、程度和发病机制的不同以及侧支循环的建立,MCAOD可造成不同类型的脑梗死和血流灌注异常.

Cerebral infarction subtypes and brain perfusion abnormalities in 116 patients with middle cerebral artery occlusive disease

Objective To study the cerebral infarction subtypes and brain perfusion abnormalities in patients with middle cerebral artery occlusive disease (MCAOD) based on findings in neuroradiological imaging. Methods In 116 MCAOD cases confirmed by CT angiography (CTA), the data of plain CT scanning, CT perfusion imaging, and CTA were retrospectively analyzed to identify the cerebral infarction subtypes and brain perfusion abnormalities. Results In the 116 cases enrolled in this study, CTA detected 133 middle cerebral arteries (MCA) with stenotie or occlusive lesions, which involved unilateral MCA in 99 cases and bilateral MCA in 17 cases. Severe MCAOD were found in 64 cases (including 25 with MCA occlusion and 39 with severe MCA stenosis), and moderate and mild MCA stenosis in 69 cases. CT or magnetic resonance imaging (MRI) identified multiple lacunar infarctions in 45 cases, territorial infarctions in 26 cases, watershed infarctions of different types in 38 cases, striatocapsular infarctions in 10 cases and no infarction associated with the stenotic MCA in 14 cases. CT perfusion imaging showed hypoperfusion areas in 96 cases (72.2%), including 58 cases with perfusion abnormalities involving large areas in the territory supplied by the MCA; no perfusion abnormalities were found in 37 cases. Conclusion According to the severity and location of MCA stenosis, pathogenesis of stroke and the establishment of collateral circulation, MCAOD may cause different types of cerebral infarction and brain perfusion abnormalities.