發(fā)布時(shí)間：2018-05-17 00:00

  本文選題：大腦中動(dòng)脈 + 動(dòng)脈粥樣硬化��； 參考：《東南大學(xué)》2016年博士論文

【摘要】：大腦中動(dòng)脈(middle cerebral artery, MCA)粥樣硬化性疾病是中國(guó)人發(fā)生缺血性腦卒中的主要原因之一。卒中危險(xiǎn)的預(yù)測(cè)因素不僅包括管腔的狹窄程度,而且與粥樣斑塊的特征密切相關(guān)。最近一些研究已證實(shí)：高分辨率磁共振(high-resolution magnetic resonance imaging, HR MRI)不僅能評(píng)估粥樣硬化性MCA狹窄的程度,而且能顯示管壁的特征。本研究旨在應(yīng)用HR MRI分析粥樣硬化性MCA狹窄的管壁特征以及與梗死類型的關(guān)系,探討HR MRI在指導(dǎo)卒中危險(xiǎn)分級(jí)及治療方案選擇的潛在價(jià)值。第一部分 癥狀性粥樣硬化性大腦中動(dòng)脈狹窄的高分辨率磁共振成像研究目的 利用HR MRI成像,比較分析有癥狀與無(wú)癥狀性粥樣硬化性MCA狹窄的管壁特征。方法 64例中重度粥樣硬化性MCA狹窄患者行3.0T HR MRI檢查,予MCA黑血技術(shù)T1加權(quán)成像(T1-weighted imaging, T1WI)、質(zhì)子密度加權(quán)成像(proton density weighted imaging, PDWI)及T2加權(quán)成像(T2-weighted imaging, T2WI)的橫斷面掃描,以及應(yīng)用可變翻轉(zhuǎn)角的三維快速自旋回波成像技術(shù)(three-dimension sampling perfection with application-optimized contrasts by using different flip angle evolutions,3D-SPACE)及其多平面重建,計(jì)算血管面積(vessel wall area, VA)、管腔面積(lumen area,LA)、斑塊面積(plaque area, PA)及重構(gòu)指數(shù)(remodeling index, RI),分析斑塊位置、形態(tài)及信號(hào)特點(diǎn),比較癥狀組與無(wú)癥狀組之間的差別。采用多因素回歸分析癥狀性粥樣硬化性MCA狹窄的獨(dú)立預(yù)測(cè)因素。結(jié)果 7例因圖像質(zhì)量差,排除研究之外。57例圖像用于最終分析,35例為癥狀性狹窄,22例為無(wú)癥狀組。癥狀組PA及RI明顯高于無(wú)癥狀組(PA：5.40±1.85mm2與4.36±1.53 mm2,P=0.046；RI：1.06±0.10與1.00±0.09,P=0.021),且正性重構(gòu)(positive remodeling, PR)、斑塊位于上壁的位置分布及斑塊表面不光整在癥狀組中更多見(P=0.038,P=0.034,P=0.032)。19例斑塊表層于T2WI可見完整弧形或斑點(diǎn)狀高信號(hào)灶,其中6例斑塊可見清晰信號(hào)分層。斑塊表層的T2WI高信號(hào)灶于兩組中無(wú)明顯統(tǒng)計(jì)學(xué)差異。斑塊位于上壁的位置分布,可作為癥狀性粥樣硬化性MCA狹窄的獨(dú)立預(yù)測(cè)因素(OR=0.226；P=0.037)。結(jié)論 癥狀性粥樣硬化性MCA狹窄常有大的斑塊負(fù)荷,且斑塊表面不光整、位于上壁的位置分布以及PR重構(gòu)方式多見。這些特征有望指導(dǎo)粥樣硬化性MCA狹窄患者的卒中危險(xiǎn)分級(jí)。第二部分 基于高分辨率磁共振成像對(duì)粥樣硬化性大腦中動(dòng)脈重構(gòu)的分析目的 利用HR MRI,探討中重度粥樣硬化性MCA狹窄不同重構(gòu)模式的管壁特征。方法 64例中重度MCA粥樣硬化性狹窄患者行3.OT MR檢查,予MCA黑血技術(shù)T1WI、PDWI、T2WI及3D-SPACE技術(shù)掃描,計(jì)算血管面積(VA)、管腔面積(LA)、斑塊面積(PA)及重構(gòu)指數(shù)(RI),分析各序列斑塊特點(diǎn),比較正性重構(gòu)(PR)及非PR組之間的差別。結(jié)果 57例圖像用于最終分析,28例為PR,29例為非PR。PR組最狹窄處的VA、管壁面積(wall area, WA)及PA較非PR組大(VAMLN：16.18±2.65mm2與14.34±2.99mm2,P=0.003；WAMLN:10.79±2.27mm2與9.00±1.77mmm2,P=0.002；PA：6.11±1.77mm2與3.93±1.OOmm2,P=0),且斑塊表面不光整(53.6%與27.6%,P=0.046)及彌散加權(quán)成像(diffusion-weighted magnetic resonance imaging, DWI)上的高信號(hào)灶(71.4%與34.5%,P=0.005)在PR組更多見。結(jié)論 有PR重構(gòu)方式的MCA粥樣硬化性狹窄患者,常有大的斑塊負(fù)荷、斑塊表面常不光整,易于發(fā)生斑塊破裂及繼發(fā)卒中的風(fēng)險(xiǎn)。第三部分 粥樣硬化性大腦中動(dòng)脈狹窄的管壁特征對(duì)腦梗死類型的預(yù)測(cè)目的 利用HR MRI,評(píng)估粥樣硬化性MCA狹窄的管壁特征,并探討管壁特征與梗死類型的關(guān)系。方法 36例有粥樣硬化性MCA狹窄的急性缺血性卒中患者行3.OT MR檢查,包括頭顱彌散加權(quán)成像(DWI)及MCA的HR MRI掃描,對(duì)斑塊表面不光整性、斑塊上壁位置分布、斑塊內(nèi)T2WI高信號(hào)灶以及正性重構(gòu)(PR)特點(diǎn)進(jìn)行分析。根據(jù)DWI圖像上急性梗死灶的數(shù)量(分為單發(fā)與多發(fā)梗死)及位置分布方式(分為皮層梗死、分水嶺梗死與穿支動(dòng)脈梗死)對(duì)梗死進(jìn)行分型,探討管壁特征與梗死類型之間的關(guān)系。結(jié)果 30例患者圖像用于最終分析。 20例粥樣硬化性MCA狹窄表現(xiàn)為PR重構(gòu)模式,18例MCA斑塊表面不光整,14例患者M(jìn)CA斑塊位于上壁,13例患者M(jìn)CA斑塊于T2WI可見高信號(hào)灶。所有急性梗死患者中,17例于DWI表現(xiàn)為多發(fā)梗死,13例表現(xiàn)為單發(fā)梗死。在多發(fā)梗死病例中,分水嶺梗死占絕大多數(shù)(76.5%)。在所有單發(fā)梗死病例中,穿支動(dòng)脈梗死占76.9%。多發(fā)梗死灶常見于有PR重構(gòu)方式(P=0.007)或斑塊表面不光整(P=0.035)的MCA狹窄患者。單發(fā)梗死,尤其是穿支動(dòng)脈梗死,多見于斑塊位于上壁的MCA粥樣硬化性狹窄的患者(P=0.030)。在所有斑塊T2WI高信號(hào)灶患者中,單發(fā)與多發(fā)梗死方式的發(fā)生率之間無(wú)統(tǒng)計(jì)學(xué)差異(P=0.638)結(jié)論 顱內(nèi)動(dòng)脈粥樣硬化性MCA狹窄的患者,若有PR重構(gòu)方式或斑塊表面不光整的管壁特征,將可能更易發(fā)生動(dòng)脈-動(dòng)脈的栓塞。斑塊位于上壁的MCA粥樣硬化性狹窄的患者,將可能多發(fā)生穿支動(dòng)脈梗死。HR MRI能活體直觀顯示粥樣硬化MCA的管壁特征,對(duì)可能發(fā)生的梗死類型有一定的預(yù)測(cè)作用。
[Abstract]:The middle cerebral artery (MCA) atherosclerotic disease is one of the main causes of ischemic stroke in China. The predictors of stroke risk not only include the stenosis of the lumen, but also are closely related to the characteristics of atherosclerotic plaques. Recent studies have confirmed that high resolution magnetic resonance (high-resolution magn). Etic resonance imaging, HR MRI) not only can assess the degree of atherosclerotic MCA stenosis, but also show the characteristics of the tube wall. This study aims to apply HR MRI to analyze the characteristics of the tube wall of atherosclerotic MCA stenosis and the relationship with the type of infarction, and to explore the potential value of HR MRI in guiding the risk classification of stroke and the choice of treatment options. High resolution magnetic resonance imaging (MRI) of symptomatic atherosclerotic middle cerebral artery stenosis (HR MRI imaging), the characteristics of symptomatic and asymptomatic atherosclerotic MCA stenosis were compared and analyzed. Methods 64 patients with moderate and severe atherosclerotic MCA stenosis were examined by 3.0T HR MRI, and MCA black blood technique was given T1 weighted imaging (T1-weig). Hted imaging, T1WI), proton density weighted imaging (proton density weighted imaging, PDWI) and T2 weighted imaging (T2-weighted imaging, T2WI) cross section scanning, and three-dimensional fast spin echo imaging technique with variable turning angle. Erent flip angle evolutions, 3D-SPACE) and its multiplane reconstruction, calculation of vascular area (vessel wall area, VA), lumen area (lumen area, LA), plaque area and reconstruction index, analysis of plaque position, shape and signal characteristics, compare the difference between symptomatic and asymptomatic groups. Multifactor factors are used. Regression analysis of independent predictors of symptomatic atherosclerotic MCA stenosis. Results 7 cases of.57 images were used for final analysis because of poor image quality, 35 cases were symptomatic and 22 were asymptomatic. The symptoms group PA and RI were significantly higher than those in the asymptomatic group (PA:5.40 + 1.85mm2 and 4.36 + 1.53 mm2, P=0.046; RI:1.06 + 0.10 and 1) 0 + 0.09, P=0.021), and positive reconstruction (positive remodeling, PR), the position distribution of the plaque on the upper wall and the plaque surface not only in the symptom group, more see (P=0.038, P=0.034, P=0.032).19 case on the surface of.19, the surface of the plaque can be seen as a complete arc or speckled high signal focus, of which 6 cases have clear signal stratification. The T2WI high letter of the plaque surface is high. There was no significant difference between the two groups. The location of the plaque located on the upper wall was an independent predictor of symptomatic atherosclerotic MCA stenosis (OR=0.226; P=0.037). Conclusion symptomatic atherosclerotic MCA stenosis often has a large plaque load, and the plaque surface is not smooth, the location of the upper wall and the mode of PR reconstruction. These features are expected to guide the risk classification of stroke in patients with atherosclerotic MCA stenosis. The second part is based on the analysis of the reconstruction of atherosclerotic middle cerebral arteries based on high resolution magnetic resonance imaging (high resolution MRI) purpose using HR MRI to explore the wall characteristics of different remodeling patterns of moderate and severe atherosclerotic MCA stenosis. Methods 64 cases of moderate to severe MCA porridge Patients with sclerosing stenosis were examined by 3.OT MR, and MCA black blood technology T1WI, PDWI, T2WI and 3D-SPACE were scanned. Vascular area (VA), lumen area (LA), patch area (PA) and reconstruction index (RI) were calculated. The characteristics of plaque in each sequence were analyzed, and the difference between positive reconstruction (PR) and non group was compared. The results of 57 cases were analyzed, 28 cases were 2, 2 9 cases were the narrowest VA in the non PR.PR group, the wall area of the tube (wall area, WA) and PA were larger than those in the non PR group (VAMLN:16.18 + 2.65mm2 and 14.34 + 2.99mm2, P=0.003, WAMLN:10.79 + and 9 +. The high signal foci on -weighted magnetic resonance imaging, DWI (71.4% and 34.5%, P=0.005) are more common in the PR group. Conclusion the patients with MCA atherosclerotic stenosis with PR remodeling often have large plaque load, the plaque surface is often not full, and the plaque rupture and the risk of subsequent stroke are prone to occur. Third parts of the atherosclerotic brain are in the middle movement. Prediction of cerebral infarction types by using HR MRI to assess the wall characteristics of atherosclerotic MCA stenosis and to explore the relationship between the canal wall characteristics and infarct types. Methods 36 cases of acute ischemic stroke with atherosclerotic MCA stenosis were examined by 3.OT MR, including cranial diffusion weighted imaging (DWI) and MCA HR MRI. The features of the plaque surface integrity, the location of the upper wall of the plaque, the T2WI high signal focus and the positive reconstruction (PR) in the plaque were analyzed. According to the number of acute infarcts on the DWI images (divided into single and multiple infarcts) and the location distribution (divided into cortical infarcts, watershed infarcts and perforating artery infarction), the infarcts were classified. The relationship between the characteristics of the wall of the tube and the type of infarction was discussed. Results 30 cases of patients were used for final analysis. 20 cases of atherosclerotic MCA stenosis showed PR remodeling pattern, 18 cases of MCA plaque surface was not light, 14 patients were located in the upper wall of MCA plaque, and 13 patients with MCA plaque on T2WI. All of the patients with acute infarction were in the DWI table. Multiple infarcts are seen in 13 cases. Among the cases of multiple infarction, watershed infarction accounts for the vast majority (76.5%). In all cases of single infarction, perforating artery infarction accounts for 76.9%. multiple infarcts in patients with MCA stenosis with PR reconstruction (P=0.007) or plaque surface incomplete (P=0.035). Single infarction, especially perforating branch Arterial infarction, mostly in patients with MCA atherosclerotic stenosis in the upper wall (P=0.030). There is no significant difference in the incidence of single and multiple infarct patterns in all patients with T2WI high signal foci (P=0.638) in patients with intracranial atherosclerotic MCA stenosis, if there is a PR remodeling mode or the plaque surface is not smooth. The characteristics of the tube wall may be more likely to occur in arterial and arterial embolization. The patients with MCA atherosclerotic stenosis at the upper wall may have perforating artery infarction.HR MRI, which can visualized the wall characteristics of the atherosclerotic MCA in vivo, and may have a certain predictive effect on the possible type of infarction.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.3;R445.2

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