本文選題：缺血性腦血管病 + 高分辨率磁共振��； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:1.應(yīng)用3.0T高分辨率磁共振(high resolution magnetic resonance imaging,HRMRI)顱內(nèi)動(dòng)脈成像,鑒別診斷缺血性腦血管病的病因;2.應(yīng)用HRMRI研究顱內(nèi)動(dòng)脈粥樣硬化性斑塊分布及其與腦梗死類(lèi)型的關(guān)系,探討腦梗死發(fā)病機(jī)制;3.應(yīng)用HRMRI研究癥狀性與非癥狀性大腦中動(dòng)脈粥樣斑塊特點(diǎn);4.應(yīng)用HRMRI研究青年和中老年缺血性腦血管病患者大腦中動(dòng)脈粥樣斑塊分布間關(guān)系。方法:按照入選和排除標(biāo)準(zhǔn),納入2015.10至2016.12月就診皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院神經(jīng)內(nèi)科(二)的癥狀性缺血性腦血管病病例49例�；颊呷朐汉笸晟蒲瘷z查,并統(tǒng)計(jì)年齡、性別、病史等基線資料。再進(jìn)行常規(guī)頭顱核磁共振(magnetic resonance imaging,MRI)檢查明確短暫性腦缺血發(fā)作(transient ischemic attack,TIA)和腦梗死診斷,彌散加權(quán)像(diffusion weighted imaging,DWI)檢查確定腦梗死類(lèi)型,磁共振血管成像(magnetic resonance angiography,MRA)檢查選取目標(biāo)血管。進(jìn)一步根據(jù)MRA定位對(duì)目標(biāo)血管行HRMRI檢查,包括雙反轉(zhuǎn)恢復(fù)T1加權(quán)像(double inverse recovery T1 weighted image,DIR T1WI)和快速自旋回波T2加權(quán)像(turbo spin echo T1 weighted image,TSE T2WI)。由兩名影像科醫(yī)師對(duì)HRMRI檢查結(jié)果行腦血管病病因診斷,評(píng)估診斷一致性和重復(fù)性。將大腦中動(dòng)脈(middle cerebral artery,MCA)斑塊位置分為上側(cè)、下側(cè)、腹側(cè)和背側(cè),基底動(dòng)脈(basilar artery,BA)斑塊位置分為腹側(cè)和背側(cè),研究顱內(nèi)動(dòng)脈粥樣硬化斑塊的分布位置,斑塊位置和腦梗死類(lèi)型的關(guān)系;進(jìn)一步研究癥狀性和非癥狀性大腦中動(dòng)脈粥樣斑塊分布關(guān)系。將49例患者劃分為青年組(≤45歲)和中老年組(45歲),探究?jī)山M間大腦中動(dòng)脈粥樣斑塊分布特點(diǎn)。結(jié)果:1.在49例患者中,男性35例(71.43%),女性14例(28.57%),年齡28-76歲,平均53.14±11.03歲;患者中高血壓31例(63.3%),糖尿病13例(26.5%),吸煙26例(53.1%),飲酒27例(55.1%)。其中,青年組中高血壓病比例為30%,而中老年組中高血壓病比例高達(dá)71.79%,兩組高血壓病患病率存在差異(P0.05)。2.44例(89.80%)診斷動(dòng)脈粥樣硬化,MCA 35例,BA 9例;3例(6.12%)診斷夾層,2例MCA,1例BA;診斷煙霧病2例(4.08%),兩位醫(yī)師對(duì)動(dòng)脈粥樣硬化診斷的組內(nèi)一致性分別是?甲=0.782(CI 0.611-0.930),?乙=0.847(CI 0.674-0.967),組間一致性為?=0.814(CI 0.640-0.961)。3.DWI診斷穿支梗死22例(62.86%),皮質(zhì)支梗死6例(17.14%),分水嶺梗死7例(20%)(?2=7.233,p0.05);27例MCA供血區(qū)梗死中穿支梗死16例(59.26%),皮質(zhì)支梗死4例(14.81%),分水嶺梗死7例(25.93%),三種梗死斑塊位于上側(cè)、下側(cè)、腹側(cè)(10例vs.1例vs.5例,2例vs.2例vs.0例,0例vs.1例vs.6例),?2=13.012,p0.01。8例BA的圖像分析,背側(cè)斑塊6例(75%),引起皮質(zhì)支梗死4例,皮層梗死2例,均是腹側(cè)斑塊。4.癥狀組35條MCA,斑塊分布于上側(cè)10條(28.57%)、下側(cè)7條(20%)、腹側(cè)14條(40%)和背側(cè)4條(11.43%),非癥狀組29條MCA斑塊中上側(cè)壁3條(10.34%),下側(cè)壁15條(51.72%),腹側(cè)壁6條(20.69%)和背側(cè)壁5條(17.24%),?2=9.323,p0.05。T1序列中,癥狀組高信號(hào)顯著多于非癥狀組(18條vs.6條),?2=6.394,p0.05。5.青年組中MCA斑塊分布于上側(cè)3條(21.43%)、下側(cè)3條(21.43%)、腹側(cè)5條(35.71%)和背側(cè)3條(21.43%),中老年組中MCA斑塊分布于上側(cè)10條(20%)、下側(cè)19條(38%)、腹側(cè)15條(30%)和背側(cè)6條(12%),兩組間斑塊位置無(wú)明顯差異(?2=1.944,P0.05)。結(jié)論:1.運(yùn)用3.0T HRMRI能夠?qū)θ毖阅X血管病病因進(jìn)行鑒別診斷,并且具有較好的一致性和重復(fù)性。2.動(dòng)脈粥樣硬化性病變是缺血性腦血管病最主要病因,MCA斑塊多分布于血管壁的下側(cè)和腹側(cè),上側(cè)壁斑塊與穿支梗死相關(guān),而分水嶺梗死斑塊則多分布于腹側(cè)壁,BA斑塊傾向于分布血管的背側(cè)壁,多引起穿支梗死。3.癥狀性大腦中動(dòng)脈斑塊與非癥狀性相比,斑塊多分布于血管的上側(cè)、腹側(cè)壁,斑塊內(nèi)高信號(hào)比例也明顯增高。4.青年缺血性腦腦血管病患者和中老年缺血性腦腦血管病患者相比,中老年組高血壓患病比例高,兩組間大腦中動(dòng)脈粥樣斑塊分布位置無(wú)明顯差異。
[Abstract]:Objective: 1. the etiology of ischemic cerebrovascular disease was identified by 3.0T high resolution magnetic resonance imaging (HRMRI) intracranial artery imaging. 2. the relationship between the distribution of atherosclerotic plaque and the type of cerebral infarction was studied with HRMRI, and the pathogenesis of cerebral infarction was discussed; 3. the symptoms of HRMRI were used to study the symptoms of cerebral infarction. Characteristics of atherosclerotic atherosclerotic plaque in the middle cerebral artery; 4. HRMRI was used to study the distribution of atherosclerotic plaques in the middle cerebral arteries of young and middle-aged patients with ischemic cerebrovascular disease. Methods: according to the criteria of admission and exclusion, the symptomatic ischemia of the neurology department of the affiliated Yi La Shan Hospital, Wangnan Medical College, from 2015.10 to 2016.12 months was included. 49 cases of sexual cerebrovascular disease. After admission to the hospital, the blood biochemical examination was perfected and the baseline data of age, sex, and history were counted. The routine head magnetic resonance (magnetic resonance imaging, MRI) was used to identify the transient ischemic attack (transient ischemic attack, TIA) and the diagnosis of cerebral infarction, and the diffusion-weighted image (diffusion weighted imag). Ing, DWI) check the type of cerebral infarction, magnetic resonance angiography (magnetic resonance angiography, MRA) check the target blood vessels. Further, according to the MRA location, the target blood vessels are examined by HRMRI, including the double inversion to restore the T1 weighted image (double inverse recovery) and the fast spin echo weighted image. Echo T1 weighted image, TSE T2WI). The diagnosis of the pathogeny of cerebrovascular disease was performed by two imaging physicians on the results of HRMRI examination. The diagnostic consistency and repeatability were evaluated. The position of the middle cerebral artery (middle cerebral artery, MCA) was divided into the upper, lower, ventral and dorsal, and the base artery (basilar) plaque was divided into the ventral side and the dorsal side. To study the distribution position of atherosclerotic plaque, the relationship between plaque position and cerebral infarction type, and further study the distribution of atherosclerotic plaque in the symptomatic and non symptomatic cerebral artery. 49 patients were divided into young group (less than 45 years old) and middle aged and elderly group (45 years old). The distribution of atherosclerotic plaque in the two groups was investigated. Results: 1 Among the 49 patients, 35 were male (71.43%), 14 (28.57%) women, 28-76 years old, with an average of 53.14 + 11.03 years, 31 (63.3%), 13 diabetes mellitus (26.5%), smoking 26 cases (26.5%), smoking 26 cases, and alcohol drinking cases in the young group. The prevalence rate was different (P0.05).2.44 (89.80%) diagnosis of atherosclerosis, MCA 35 cases, BA 9 cases, 3 cases (6.12%) diagnosis of interlayer, 2 cases of MCA, 1 cases of BA, diagnosis of moyamoya disease (4.08%), two physicians in the diagnosis of atherosclerosis, =0.782 (CI 0.611-0.930), B =0.847 (CI 0.674-0.967), the conformance of group is? CI 0.640-0.961).3.DWI diagnosed perforating infarction in 22 cases (62.86%), cortical branches infarction in 6 cases (17.14%), watershed infarcts in 7 cases (20%) (? 2=7.233, P0.05); 27 cases of MCA blood supply area perforating infarction 16 cases (59.26%), 4 cases (14.81%) of cortical branches infarction, 6 infarcts in the upper, lower and ventral cases of vs.1 cases, vs.1 cases, vs.5 cases. Vs.2 cases vs.0, 0 vs.1 cases vs.6 cases, 2=13.012, p0.01.8 cases BA image analysis, 6 cases of dorsal plaque (75%), cortical branches infarction, 2 cases of cortical infarct, 35 MCA in the abdominal plaque.4. symptom group, 10 plaques in the upper side (28.57%), inferior 7 (20%), 14 (40%) and dorsal 4 (11.43%) in the ventral side, and the upper MCA plaque in the non symptomatic group. The lateral wall 3 (10.34%), the lower lateral wall 15 (51.72%), the ventral wall 6 (20.69%) and the dorsal side wall 5 (17.24%), 2=9.323, p0.05.T1, the symptom group was significantly more high signal than the non symptomatic group (18 vs.6),? 2=6.394, the MCA plaque in the p0.05.5. youth group was 3 (21.43%), inferior 3 (21.43%), ventral 5 The MCA plaques in the middle and old age group were 10 (20%), 19 (38%) in the lower side, 15 in the ventral side (30%) and 6 in the back (12%). There was no significant difference between the two groups (? 2=1.944, P0.05). Conclusion: 1. using 3.0T HRMRI can be used to differentiate the etiology of ischemic cerebrovascular disease, and it has good consistency and repeatability of.2. atherosclerosis. The most important cause of ischemic cerebrovascular disease is sexual disease. MCA plaques are mostly distributed on the lower and ventral sides of the vascular wall. The plaque of the upper wall is associated with perforating infarction, while the watershed infarcts are mostly distributed on the ventral wall, and the plaque of BA tends to distribute the dorsal wall of the blood vessels, causing the perforating branches to die.3. symptomatic plaque and the non symptomatic phase of the cerebral artery. The proportion of plaques distributed on the upper side of the blood vessels, the ventral wall, and the high signal ratio in the plaques increased obviously. Compared with the patients with ischemic cerebrovascular disease in.4. youth and the elderly patients with ischemic cerebrovascular disease, the proportion of hypertension in the middle aged and elderly groups was high, and there was no significant difference in the distribution of the plaque in the middle cerebral arteries between the two groups.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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