对比分析高分辨MRI与MRA对穿支动脉供血区脑梗死责任血管的诊断价值

目的对比分析高分辨率MRI(HRMRI)与MRA对穿支动脉供血区脑梗死患者责任血管的诊断评估价值。方法对24例穿支动脉供血区脑梗死患者进行常规MRI、MRA检查,根据梗死区解剖学的血管支配参照MRA行相应责任血管的HRMRI检查。Fisher精确概率法比较HRMRI与MRA对穿支动脉的载体血管(大脑中动脉、椎动脉、基底动脉)狭窄的识别情况;Wilcoxon配对秩和检验比较HRMRI与MRA评估的穿支动脉载体血管的狭窄程度。分析患者颅内动脉斑块的特征、斑块对穿支血管开口及本身的影响。结果24例患者,梗死灶位于基底节区17例、脑干7例(其中3例小脑受累)。共检查24支穿支动脉载体血管包括大脑中动脉17支、椎动脉1支、基底动脉6支。HRMRI判断责任载体血管狭窄的检出率(91.67%,22/24)明显高于MRA(62.5%,15/24)(P0.05)。对狭窄程度的判断HRMRI比MRA更准确(Z=91,P0.05)。HRMRI示23支载体血管有斑块形成,1支内膜增厚。8例HRMRI显示斑块覆盖或累及穿支血动脉开口;5例HRMRI示穿支动脉本身狭窄。而MRA不能显示穿支动脉及开口情况(P0.05)。结论 HRMRI对穿支动脉的载体血管有无狭窄及狭窄程度的判断优于MRA,还能显示穿支动脉本身管径和开口受累情况,为穿支动脉供血区脑梗死的发生机制提供更多的循证医学的依据。

Comparative study of diagnostic value of high resolution MRI and MRA on responsible artery for perforating artery territory infarction

Objective To compare the diagnostic value of high resolution MRI ( HRMRI ) and MRA on responsible artery for perforating artery territory infarction.Methods Twenty-four patients with perforating artery territory infarction underwent routine MRI, MRA, and HRMRI on responsible arteries.The detection rates of medium artery such as middle cerebral artery, vertebral artery, basilar artery stenosis were compared by Fisher’ s exact test, and the ratios of stenosis were compared by Wilcoxon paired rank sum test between HRMRI and MRA.In HRMRI images the characteristics of guilty vascular plaques were assessed.Results The infarct areas were at basal ganglia in 17 cases and at brainstem in 7 cases ( including 3 cases with cerebellum involved) , respectively.A total of 24 responsible medium arteries were assessed including 17 middle cerebral artery, 1 vertebral artery, 6 basilar artery. HRMRI on detecting stenosis (91.67%, 22/24) was superior to MRA (62.5%, 15/24) (P<0.05).HRMRI was more accurate than MRA in assessing stenosis rates of the medium artery(Z=91, P<0.05).The plaques were found in 23 guilty medium vessels, in addition to 1 with intimal hyperplasia.In 8 cases, the plaques covered the opening of the perforating arteries and stenosis of perforating arteries were observed in 5 cases on HRMRI images.While perforating arteries and its opening couldn’ t be seen on MRA (P<0.05).Conclusions HRMRI is superior to MRA in evaluating the stenosis of responsible medium artery for infarction in perforating artery.It’ s also helpful to display the opening and stenosis of perforating artery.It is useful to provide evidence for illustrating the mechanism of perforating artery territory infarction.