颅内VW-MRI豆纹动脉成像：大脑中动脉粥样硬化斑块与梗死类型的关系

目的 基于高分辨MR血管壁成像（VW-MRI）技术探讨不同类型脑梗死病人的大脑中动脉（MCA）斑块体积和豆纹动脉（LSA）数量、长度间的关系。方法 回顾性纳入因可疑脑卒中或其他脑血管病行头颅MRI检查的病人58例,均经VW-MRI检查明确诊断。其中,单侧基底节区急性脑梗死病人39例[男28例,女11例,年龄45~75岁,平均（60.92±12.21）岁],根据其MR影像分为大动脉粥样硬化型[较大皮质下梗死（LSI）]组21例和小动脉闭塞型[较小腔隙性梗死（SLI）]组18例;其余19例无急性脑梗死灶且单侧MCA无斑块的病人作为对照组[男8例,女11例,年龄42~81岁,平均（63.84±12.05）岁]。由2名放射科医生统计3组临床资料并测量LSA长度、数量,利用斑块软件测量LSI组和SLI组的MCA M1-2段斑块体积。2组间比较采用独立样本t检验,3组间比较采用单因素方差分析或χ²检验。采用无序多分类logistic回归分析不同梗死类型的影响因素。采用组内相关系数（ICC）评价2名医师测量数据的一致性。结果 3组病人临床资料差异均无统计学意义（均P>0.05）。LSI、SLI和对照组的LSA平均分支长度和分支数量分别为13.48±2.99、15.8±2.71、（16.4±2.69） mm和2.00±0.77、2.78±0.94、（3.11±1.15）支,组间差异均有统计学意义（均P<0.05）。其中,LSI组的分支长度、数量最小（P<0.05）,SLI组和对照组间差异均无统计学意义（均P>0.05）。LSI组的斑块体积大于SLI组[分别为（87.5±17.7） mm³、（75.5±9.4） mm³,t=2.579,P=0.014]。LSA长度越短和分支数越少则LSI型的风险增加,OR（95%CI）值分别为0.665（0.497~0.890）、0.253（0.106~0.604）。2名医师测量斑块体积和长度的一致性较好,ICC分别为0.78和0.84。结论 采用VW-MRI对MCA及LSA成像有助于揭示深穿支梗死类型的发生机制,其中MCA斑块体积及LSA数量和长度是影响脑梗死分型的关键因素。

Visualization of lenticulostriate arteries on intracranial VW-MRI:relationship between MCA atherosclerotic plaque and infarction types

Objective Using vessel wall magnetic resonance imaging(VW-MRI)technique to investigate the relationship between the middle cerebral artery(MCA)plaque volume and the number and length of the lenticulostriate artery(LSA)in patients with different types of infarction.Methods Retrospective inclusion was performed on 58 patients with suspected stroke or other cerebrovascular diseases who had received head MRI examination,and all patients were definitively diagnosed by VW-MRI examination.Among them,thirty-nine patients with unilateral acute cerebral infarction in basal ganglia region[28 males and 11 females,age range 45-75 years old,average 60.92±12.21 years],and 19 patients without unilateral MCA plaque and acute cerebral infarction were used as control group[8 males and 11 females,age range 42-81 years old,average 63.84±12.05 years].Clinical data of the 3 groups were collected by 2 radiologists and the length and number of the lenticulostriate arteries were measured.The plaque volume of MCA M1-2 segments in the LSI group and the SLI group were measured with plaque software.Comparison between the 2 groups was conducted with Student’s t test,and comparison between the 3 groups was conducted with One-way ANOVA or chi-square test.Multivariate logistic regression analysis was used to analyze the influencing factors of different types of infarction.Intraclass correlation coefficient(ICC)was used to check the repeatability of measurements between two radiologists.Results There were no statistical difference in the clinical data among the three groups(all P>0.05).The average branch length and number of LSA in LSI,LSI,and control group were 13.48±2.99 mm,15.8±2.71 mm,and 16.4±2.69 mm,and 2.00±0.77,2.78±0.94,and 3.11±1.15,respectively,the differences were statistically significant(all P<0.05).The branch length and number were smallest in the LSI group(P<0.05),and they did not significantly differ between the SLI group and the control group(P>0.05).The plaque volume was higher in the LSI group than that in the SLI group[(87.5±17.7)mm3 and(75.5±9.4)mm3,t=2.579,P=0.014].The shorter the length and the fewer number of LSA significantly increased the risk of SLI[OR=0.665,95%confidence interval(CI):0.497-0.890,P<0.05;OR=0.253,95%CI:0.106-0.604,P<0.05,respectively).Plaque volume and length measured by the two radiologists were consistent,with ICC values of 0.78 and 0.84,respectively.Conclusion VW-MRI imaging of MCA and LSA is helpful to reveal the mechanism of deep perforation infarction,and the plaque volume of MCA and the length and number of LSA are the key factors affecting the types of cerebral infarction.