本文選題：高分辨率磁共振 + 大腦中動脈��； 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:使用高分辨率磁共振(high-resolution magnetic resonance imaging,HRMRI)成像方法,探討大腦中動脈(middle cerebral artery,MCA)粥樣硬化斑塊的分布特征,并進一步分析斑塊分布與急性腦梗死的關(guān)系。方法:收集2015年8月-2016年4月南京市第一醫(yī)院神經(jīng)內(nèi)科33例有臨床癥狀的MCA粥樣硬化狹窄的病人,先進行常規(guī)頭顱磁共振掃描,MRA發(fā)現(xiàn)有單側(cè)MCA主干狹窄時,再垂直于MCA狹窄處進行黑血技術(shù)T1加權(quán)成像(Tl-weightedimaging,T1WI)、T2 加權(quán)成像(T2-weighted imaging,T2WI)掃描。將動脈粥樣硬化斑塊的分布位置分為前壁、下壁、后壁、上壁;依據(jù)彌散加權(quán)圖像上MCA供血區(qū)有無高信號,將研究對象分為急性腦梗死、無急性腦梗死。統(tǒng)計斑塊各分布部位例數(shù)及其相應(yīng)的急性腦梗死的例數(shù)。結(jié)果:33例圖像納入研究,斑塊的分布情況為前壁14例、下壁7例、上壁4例、后壁4例,余4例為管腔完全閉塞,各分布部位的相應(yīng)急性腦梗死例數(shù)為2、2、4、3,4例閉塞者均有急性腦梗死;位于上壁或后壁的斑塊較位于前壁或下壁斑塊更易引起急性腦梗死,差異有統(tǒng)計學(xué)意義(P=0.001)。結(jié)論:大腦中動脈粥樣硬化狹窄處的斑塊好發(fā)于血管的前壁和下壁,但位于上壁或后壁粥樣硬化斑塊更易引發(fā)急性腦梗死。目的:近年來,HRMRI被用于顯示顱內(nèi)動脈血管壁的結(jié)構(gòu)特點,本文使用HRMRI成像方法,分析動脈粥樣硬化性MCA狹窄處血管壁的重構(gòu)方式及其與急性腦梗死之間的關(guān)系。方法:收集2015年8月至2016年4月我院神經(jīng)內(nèi)科33例有頭暈、言語不清、肢體無力、意識不清等癥狀的病人,常規(guī)頭顱磁共振檢查時MRA發(fā)現(xiàn)單側(cè)粥樣硬化性MCA主干狹窄的,則垂直于狹窄處進行黑血技術(shù)T1WI、T2WI、PDWI血管壁掃描。計算最狹窄處的血管面積、管腔面積、管壁面積、斑塊面積、重構(gòu)指數(shù)以及記錄病人入院時的NIHSS(NationalInstitute of Health stroke scale,美國國立衛(wèi)生研究院卒中量表)評分,比較急性腦梗組與無急性腦梗組之間、正性重構(gòu)組與非正性重構(gòu)組之間的血管壁各測量參數(shù)及NIHSS分?jǐn)?shù)的差異。結(jié)果:33例圖像用于分析,其中,急性腦梗組有15例,無急性腦梗組有18例;正性重構(gòu)組有14例,非正性重構(gòu)組有19例。在MCA最狹窄處,急性腦梗組的較無急性腦梗組有更大的重構(gòu)指數(shù)[(1.07±0.09)比(0.94±0.08),P0.001]、斑塊面積[(4.76±2.00)mm2比(2.33±1.32)mm2,P0.001]、管壁面積[(13.84±3.05)mm2比(11.79±2.44)mm2,P=0.04]、NIHSS分值[(4.87±2.88)比(1.44±3.07),P=0.003]。急性腦梗組中正性重構(gòu)較多(12例),無急性腦梗組中負(fù)性重構(gòu)較多(11例),差異有統(tǒng)計學(xué)意義(P=0.002)。與非正性重構(gòu)組相比,正性重構(gòu)組有更大的斑塊面積[(4.42±2.05)mmm2比(2.70±1.75)mm2,P=0.014]、NIHSS分值[(4.43±3.37)比(1.95±3.12),P=0.037]。正性重構(gòu)組有12例MCA供血區(qū)出現(xiàn)急性腦梗死,非正性重構(gòu)組有3例,差異有統(tǒng)計學(xué)意義(P0.001)。結(jié)論:急性腦梗組在MCA粥樣硬化性狹窄處以正性重構(gòu)方式為主,較無急性腦梗組有更大的斑塊負(fù)荷、重構(gòu)指數(shù)。正性重構(gòu)較非正性重構(gòu)更易引起腦梗死,是一種不穩(wěn)定的重構(gòu)方式。目的 使用HRMRI成像方法,評估大腦中動脈粥樣硬化斑塊的強化程度與腦梗死之間的關(guān)系。方法 收集2015年8月至2016年4月33例我院神經(jīng)內(nèi)科有腦缺血癥狀且MRA顯示單側(cè)MCA主干狹窄的病人,行常規(guī)頭顱MR檢查后,再垂直于血管狹窄處進行黑血序列T1WI、T2WI、增強T1WI掃描。根據(jù)彌散加權(quán)成像上狹窄側(cè)MCA供血區(qū)有無高信號,將病人分為急性腦梗組、無急性腦梗組。將增強后斑塊的強化程度分為明顯強化、輕度強化、無強化,比較兩組間粥樣硬化斑塊的三種強化方式例數(shù)的差異。結(jié)果33例圖像納入研究,急性腦梗組有15例,無急性腦梗組有18例。急性腦梗組有11例明顯強化、1例輕度強化、3例無強化;無急性腦梗組有1例明顯強化、4例輕度強化、13例無強化。急性腦梗組的明顯強化斑塊多于無急性腦梗組(P=0.000);無強化斑塊少于無急性腦梗組(P=0.005),差異具有統(tǒng)計學(xué)意義。結(jié)論 HRMRI增強掃描可以觀察MCA粥樣硬化斑塊的強化程度;斑塊的明顯強化更多見于急性腦梗組,提示其不穩(wěn)定性,可預(yù)測腦卒中的風(fēng)險。
[Abstract]:Objective: To explore the distribution characteristics of the atherosclerotic plaque of the middle cerebral artery (middle cerebral artery, MCA), and to further analyze the relationship between the plaque distribution and the acute cerebral infarction by using the high-resolution magnetic resonance imaging (HRMRI) imaging method. Methods: to collect the God of the first hospital of Nanjing in August 2015 and April. 33 cases of MCA atherosclerotic stenosis with clinical symptoms were scanned with conventional cranial magnetic resonance (MRI), and MRA was found to have T1 weighted imaging (Tl-weightedimaging, T1WI), T2 weighted imaging (T2-weighted imaging, T2WI) scan at MCA stenosis at MCA stenosis. The atherosclerotic plaque was observed. The distribution position was divided into the anterior wall, the lower wall, the posterior wall and the upper wall. According to the MCA blood supply area on the diffusion-weighted image, there were no high signals, and the subjects were divided into acute cerebral infarction, no acute cerebral infarction. The number of distribution parts of plaque and the number of corresponding acute cerebral infarction were counted. Results: 33 cases were included in the study, and the distribution of plaque was 14 cases of anterior wall. There were 7 cases in the lower wall, 4 cases in the upper wall, 4 cases in the posterior wall and 4 cases of complete occlusion of the lumen. The number of corresponding acute cerebral infarction in each distribution area had acute cerebral infarction in 2,2,4,3,4 cases. The plaques located at the upper wall or the posterior wall were more susceptible to acute cerebral infarction than the anterior or lower wall plaques. The difference was statistically significant (P=0.001). Conclusion: middle cerebral artery (middle cerebral artery). Atherosclerotic plaque at the atherosclerotic stenosis occurs well in the anterior and lower walls of the vessel, but the atherosclerotic plaque at the upper wall or the posterior wall is more likely to cause acute cerebral infarction. Objective: in recent years, HRMRI has been used to display the structural characteristics of the vascular wall of the intracranial arteries. In this paper, the reconstruction of the vascular wall at the atherosclerotic MCA stenosis was analyzed by HRMRI imaging. Formula and its relationship with acute cerebral infarction. Methods: from August 2015 to April 2016, 33 patients with symptoms such as dizziness, poor speech, weak limbs and unconsciousness were collected from the Department of Neurology of our hospital from August 2015 to April 2016. At the time of routine head magnetic resonance examination, MRA found that the unilateral atherosclerotic MCA trunk was narrow and narrow, then the black blood technique T1WI, T2WI was carried out vertically to the stenosis. PDWI vascular wall scan. Calculate the vascular area, lumen area, wall area, patch area, remodeling index, and NIHSS (NationalInstitute of Health stroke scale, National Institutes of Health Stroke Scale) score at the admission of patients, compared with the acute cerebral infarction group and the non acute cerebral infarction group. Results of 33 cases of acute cerebral infarction, there were 15 cases of acute cerebral infarction, 18 cases without acute cerebral infarction, 14 in the positive reconfiguration group and 19 in the non positive reconstruction group. In the narrowest MCA, the acute cerebral infarction group had a larger reconstruction index than that in the non acute cerebral infarction group (1). 7 + 0.09) ratio (0.94 + 0.08), patch area [(4.76 + 2) mm2 ratio (2.33 + 1.32) mm2, P0.001], tube wall area [(13.84 + 3.05) mm2 ratio (11.79 + 2.44)), P=0.04], NIHSS score [(4.87 +]), more positive reconstruction in P=0.003]. acute cerebral infarction group. There was no statistical difference in acute cerebral infarction group (cases), the difference was statistically significant Learning significance (P=0.002). Compared with the non positive reconstruction group, the positive reconstruction group had larger patch area [(4.42 + 2.05) mmm2 ratio (2.70 + 1.75) mm2, P=0.014], NIHSS score [(4.43 + 3.37) ratio (1.95 + 3.12)). There were 12 patients with MCA in the P=0.037]. positive reconstruction group with acute cerebral infarction and 3 cases in the non positive reconstruction group, the difference was statistically significant (P0.001). In the acute cerebral infarction group, there is a positive reconstruction in MCA atherosclerotic stenosis, which is more likely to cause cerebral infarction than the non positive reconstruction. The objective of HRMRI imaging is to evaluate the strength of the atherosclerotic plaque in the brain. Methods the relationship between the degree of cerebral infarction and cerebral infarction was collected. Methods 33 patients with cerebral ischemia in our hospital from August 2015 to April 2016 were collected and MRA showed unilateral MCA trunk stenosis. After routine head MR examination, T1WI, T2WI, and enhanced T1WI scan were performed vertically to the stenosis of blood vessels. MCA in the narrow side of the stenosis weighted imaging MCA. There were no high signals in the blood supply area. The patients were divided into acute cerebral infarction group and no acute cerebral infarction group. The enhancement degree of the enhanced plaque was divided into obvious strengthening, mild strengthening and no enhancement. The difference of the number of three intensification methods of atherosclerotic plaque between the two groups was compared. The results of 33 cases were included in the study, the acute cerebral infarction group had 15 cases, and the non acute cerebral infarction group had 18. In acute cerebral infarction group, there were 11 cases of obvious enhancement, 1 cases of mild strengthening, 3 cases without enhancement, 1 cases in the acute cerebral infarction group, 4 cases of mild strengthening and 13 cases without enhancement. The obvious enhanced plaque in the acute cerebral infarction group was more than that in the non acute cerebral infarction group (P=0.000), and the non intensification plaque was less than the non acute cerebral infarction group (P=0.005), the difference was statistically significant. Conclusion HRMR I enhanced scan can observe the intensification of MCA atherosclerotic plaque, and the obvious enhancement of plaque is more seen in the acute cerebral infarction group, indicating its instability and predicting the risk of cerebral apoplexy.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R445.2

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