内侧分水岭梗死的临床和影像学特点及与颈动脉系统病变的关系

目的探讨内侧分水岭梗死（IWI）的临床和影像学特点及与颈动脉系统病变的关系。方法选择DWI病灶符合内侧分水岭梗死的患者27例，将其分为融合型IWI（CIWI）及部分型IWI（PIWI）。行头部颈动脉MRA和（或）DSA进行血管评价，确定主要责任血管病变；于入院第1天及第7天测量NIHSS评分，确定病情；卒中后3个月采用修订的Rankin评分评价预后。结果27例IWI患者中14例为融合型，13例为部分型；22例（82％）有颈动脉系统严重狭窄或闭塞，其中CIWI12例，PIWI10例，差异无统计学意义（P〉0．05）。CIWI患者ICA病变的发生比例高于PIWI患者（11／14，4／13），多表现为非腔隙综合征（10／14，4／13）；PIWI患者MCA病变的发生比例高于CIWI患者（6／13，1／14），多表现为腔隙综合征（9／13，4／14），差异有统计学意义（P〈0．05）。CIWI患者较PIWI患者7d内多见病程进展，且3个月预后差（5／14，0／13；P〈0．05）。结论IWl与颈动脉系统病变存在比较确切的关系，CIWI和PIWI发病机制中受累的血管作用存在一定差异。

The relationship between clinical and imaging characteristics of internal watershed infarction and carotid system lesions

Objective To investigate clinical and imaging characteristics of internal watershed infarction(IWI)and their relationship with carotid system lesions.Methods Twenty-seven patients whose lesions on diffusion-weighted imaging(DWI)in accordance with IWI were selected.The patients were divided into confluent IWI group(CIWI;n=14)and partial IWI(PIWI;n=13)group.Carotid artery magnetic resonance angiography(MRA)and/or digital subtraction angiography(DSA)were performed to evaluate vascular status,and the lesions in the responsible vessels were identified;NIHSS scores were measured at day 1 and day 7 of admission,and the course of diseases was determined;the prognosis was evaluated by the modified Rankin!Scale at 3 months after stroke.Results Of the 27 patterns with IWI,22(82%)had severe carotid stenosis or occlusion,among them 12 had CIWI and 10 had PIWI,and there was no statistical difference(P>0.05).The incidence of ICA lesions in patients with CIWI was higher than that in patients with PIWI(11/14 vs.4/13),most of them presented as nonlacunar syndrome(10/14 vs.4/13);the incidence of ICA lesions in patients with PIWI was higher than that in patients with CIWI(6/13 vs.1/14),most of them presented as lacunar syndrome(9/13 vs.4/14),and there was statistical difference(P<0.05).The progression of the course of diseases was often observed within 7 days and the prognosis was poor at 3 months in patients with CIWI as compared with patients with PIWI(5/14 vs.0/13;P<0.05).Conclusion IWI has a relatively exact relationship with carotid system lesions.The effect of affected vessel may have some differences in the pathogenesis of CIWI and PIWI.