高分辨率磁共振對大腦中動脈斑塊特征及其對梗死類型、機(jī)制預(yù)測價值的研究
發(fā)布時間：2019-01-02 19:04
【摘要】：目的:運用3.0T高分辨率磁共振(High-resolution MRI,HR MRI)技術(shù)評估大腦中動脈粥樣硬化斑塊,結(jié)合臨床表現(xiàn)分析罪犯血管與非罪犯血管之間的斑塊特征及差異,并進(jìn)一步分析斑塊分布位置與梗死類型之間的關(guān)系,探討可能的卒中發(fā)病機(jī)制。方法:收集2014年09月至2017年03月于南昌大學(xué)第二附屬醫(yī)院行常規(guī)磁共振序列(包括T1WI、T2WI、T2-FLAIR、3D-TOF-MRA、DWI)及大腦中動脈高分辨率掃描序列同時符合入選標(biāo)準(zhǔn)的患者64例。所有患者使用3.0T(GE Signa 3.0T Excite HD Systems)GE8通道線圈掃描經(jīng)MRA確診或可疑狹窄的MCA,將納入患者按照是否存在卒中癥狀分為有癥狀及無癥狀MCA斑塊組,然后將掃描的MCA根據(jù)是否為梗死灶的責(zé)任血管分為罪犯血管組和非罪犯血管組。收集臨床資料、實驗室檢查、斑塊特征、狹窄程度及腦梗死類型等,分析有癥狀MCA組與無癥狀MCA組之間的臨床特點及罪犯血管組與非罪犯血管組的斑塊特征差異,同時對斑塊分布位置與梗死類型進(jìn)行分析,探討可能的卒中機(jī)制。所有數(shù)據(jù)采用SPSS17.0軟件進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:1、本研究中符合入選標(biāo)準(zhǔn)的患者64例(其中男45例,女19例,年齡位于26-87歲之間,年齡59±12歲)及掃描的MCA 76根。其中,有癥狀MCA斑塊組43例,非癥狀MCA斑塊組21例;罪犯血管組44根,非罪犯血管組32根。有癥狀組平均年齡為60±14歲,而非癥狀組為58±7歲,在兩組中年齡、性別均無統(tǒng)計學(xué)意義(P0.05)。此外,在兩組間既往史(包括高血壓病史、糖尿病病史、高脂血癥、高胱氨酸血癥、吸煙史)及實驗室檢查結(jié)果(總膽固醇、甘油三酯、低密度脂蛋白)亦無統(tǒng)計學(xué)意義(P0.05)。2、罪犯血管組與非罪犯血管組之間斑塊指標(biāo)包括LA(2.28±1.69 VS 2.31±1.61,P=0.807)、WA(5.70±2.43 VS 5.32±1.58,P=0.444)、VA(7.95±2.97 VS 7.69±2.49,P=0.844)、PB(0.72±0.17 VS 0.72±0.16,P=0.883)、RI(0.75±0.25 VS 0.81±0.24,P=0.324)、狹窄程度(P=0.715)、重塑類型(P=0.854)、斑塊分布位置(上壁P=0.845;下壁P=0.084;前壁P=0.966;后壁P=0.389)、表面是否規(guī)則(P=0.873)及斑塊穩(wěn)定性(P=0.283)均無統(tǒng)計學(xué)意義(P0.05),而兩組之間增厚模式存在統(tǒng)計學(xué)意義(P0.05),均以偏心性增厚多見,罪犯血管組比例更大。3、掃描的76例斑塊中,分別位于上壁32例(42.1%)、下壁30例(39.5%)、前壁7例(9.2%)及后壁7例(9.2%)。統(tǒng)計分析結(jié)果顯示斑塊更常見于上下壁,其中無梗死灶患者斑塊以上、下壁為主,皮層下梗死以下壁斑塊為主,3例大面積梗死及大部分穿支血管梗死患者的斑塊均位于上壁,但差異均無統(tǒng)計學(xué)意義(P0.05)。4、納入的76例斑塊中男性占53例(69.7%),女性占23例(30.3%)。斑塊各分布位置男女比例無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:MCA狹窄患者偏心性增厚可能與不穩(wěn)定斑塊有關(guān);斑塊位置尤其是上壁斑塊,可能有助于判斷梗死類型及了解缺血性√事件的基本機(jī)制。
[Abstract]:Objective: to evaluate atherosclerotic plaques in middle cerebral artery by using 3.0T high-resolution magnetic resonance imaging (High-resolution MRI,HR MRI) technique, and to analyze the plaque characteristics and differences between convict and non-convict vessels in combination with clinical manifestations. Furthermore, the relationship between plaque location and infarction type was analyzed to explore the possible pathogenesis of stroke. Methods: routine MRI sequences (including T1WIN T2WIT2-FLAIRN 3D-TOF-MRAA) were performed in the second affiliated Hospital of Nanchang University from September 2014 to March 2017. DWI) and high-resolution scan sequence of middle cerebral artery (MCA) in 64 patients who met the inclusion criteria at the same time. All patients were divided into symptomatic and asymptomatic MCA plaque groups according to the presence or absence of stroke symptoms using 3.0T (GE Signa 3.0T Excite HD Systems) GE8 channel coil scanning MCA, diagnosed by MRA or suspected stenosis. The scanned MCA was then divided into the convict group and the non-convict group according to whether the responsible vessels were infarcted or not. The clinical data, laboratory examination, plaque characteristics, degree of stenosis and type of cerebral infarction were collected to analyze the clinical characteristics of symptomatic MCA group and asymptomatic MCA group, and the differences of plaque characteristics between culprit vascular group and non-criminal vascular group. At the same time, the location of plaque distribution and infarction type were analyzed to explore the possible mechanism of stroke. All the data were analyzed by SPSS17.0 software. Results: 1. In this study, 64 patients (45 males and 19 females, aged between 26 and 87 years, 59 鹵12 years old) and 76 MCA were included in the study. There were 43 symptomatic MCA plaques, 21 asymptomatic MCA plaques, 44 convict vessels and 32 non-convict vessels. The average age of the symptomatic group was 60 鹵14 years old, while that of the non-symptomatic group was 58 鹵7 years old. There was no significant difference in age and sex between the two groups (P0.05). In addition, previous history between the two groups (including hypertension, diabetes, hyperlipidemia, hypercysteinemia, smoking history) and laboratory results (total cholesterol, triglyceride), There was also no significant difference in low density lipoprotein (P0.05). The plaque index between the culprit vascular group and the non-convict vascular group included LA (2.28 鹵1.69 VS 2.31 鹵1.61 VS 0.807), WA (5.70 鹵2.43 VS 5.32 鹵1.58). Pn0.444), VA (7.95 鹵2.97 VS 7.69 鹵2.49), PB (0.844), PB (0.72 鹵0.17 VS 0.72 鹵0.16), RI (0.883), RI (0.75 鹵0.25 VS 0.81 鹵0.24 VS 0.324), the degree of stenosis was 0.715. The type of remodeling (P0. 854), the location of plaques (P < 0. 845); The inferior wall was 0.084, the anterior wall was 0.966; There was no significant difference in the posterior wall (P < 0. 389), surface regularity (P < 0. 873) and plaque stability (P 0. 283) (P0.05), but there was significant difference in the thickening pattern between the two groups (P 0. 05). The percentage of culprit vessels was much larger. In 76 cases, 32 cases were located in the superior wall (42.1%), 30 cases in the inferior wall (39.5%), 7 cases in the anterior wall (9.2%) and 7 cases in the posterior wall (9.2%). The results of statistical analysis showed that the plaques were more common in the upper and lower wall of the patients with no infarct. The plaques in the subcortical and subcortical infarcts were more common in the patients with large area infarction and most perforating vessel infarction, and the plaques were located in the superior wall in the patients with no infarct foci. However, there was no significant difference between the two groups (P0.05). Among the 76 plaques included, 53 (69.7%) were male and 23 (30.3%) were female. There was no significant difference between male and female in the distribution of plaque (P0.05). Conclusion: eccentric thickening in patients with MCA stenosis may be associated with unstable plaque, and the location of plaque, especially in the upper wall, may be helpful to judge the type of infarction and to understand the basic mechanism of ischemic events.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R445.2
本文編號：2398865
[Abstract]:Objective: to evaluate atherosclerotic plaques in middle cerebral artery by using 3.0T high-resolution magnetic resonance imaging (High-resolution MRI,HR MRI) technique, and to analyze the plaque characteristics and differences between convict and non-convict vessels in combination with clinical manifestations. Furthermore, the relationship between plaque location and infarction type was analyzed to explore the possible pathogenesis of stroke. Methods: routine MRI sequences (including T1WIN T2WIT2-FLAIRN 3D-TOF-MRAA) were performed in the second affiliated Hospital of Nanchang University from September 2014 to March 2017. DWI) and high-resolution scan sequence of middle cerebral artery (MCA) in 64 patients who met the inclusion criteria at the same time. All patients were divided into symptomatic and asymptomatic MCA plaque groups according to the presence or absence of stroke symptoms using 3.0T (GE Signa 3.0T Excite HD Systems) GE8 channel coil scanning MCA, diagnosed by MRA or suspected stenosis. The scanned MCA was then divided into the convict group and the non-convict group according to whether the responsible vessels were infarcted or not. The clinical data, laboratory examination, plaque characteristics, degree of stenosis and type of cerebral infarction were collected to analyze the clinical characteristics of symptomatic MCA group and asymptomatic MCA group, and the differences of plaque characteristics between culprit vascular group and non-criminal vascular group. At the same time, the location of plaque distribution and infarction type were analyzed to explore the possible mechanism of stroke. All the data were analyzed by SPSS17.0 software. Results: 1. In this study, 64 patients (45 males and 19 females, aged between 26 and 87 years, 59 鹵12 years old) and 76 MCA were included in the study. There were 43 symptomatic MCA plaques, 21 asymptomatic MCA plaques, 44 convict vessels and 32 non-convict vessels. The average age of the symptomatic group was 60 鹵14 years old, while that of the non-symptomatic group was 58 鹵7 years old. There was no significant difference in age and sex between the two groups (P0.05). In addition, previous history between the two groups (including hypertension, diabetes, hyperlipidemia, hypercysteinemia, smoking history) and laboratory results (total cholesterol, triglyceride), There was also no significant difference in low density lipoprotein (P0.05). The plaque index between the culprit vascular group and the non-convict vascular group included LA (2.28 鹵1.69 VS 2.31 鹵1.61 VS 0.807), WA (5.70 鹵2.43 VS 5.32 鹵1.58). Pn0.444), VA (7.95 鹵2.97 VS 7.69 鹵2.49), PB (0.844), PB (0.72 鹵0.17 VS 0.72 鹵0.16), RI (0.883), RI (0.75 鹵0.25 VS 0.81 鹵0.24 VS 0.324), the degree of stenosis was 0.715. The type of remodeling (P0. 854), the location of plaques (P < 0. 845); The inferior wall was 0.084, the anterior wall was 0.966; There was no significant difference in the posterior wall (P < 0. 389), surface regularity (P < 0. 873) and plaque stability (P 0. 283) (P0.05), but there was significant difference in the thickening pattern between the two groups (P 0. 05). The percentage of culprit vessels was much larger. In 76 cases, 32 cases were located in the superior wall (42.1%), 30 cases in the inferior wall (39.5%), 7 cases in the anterior wall (9.2%) and 7 cases in the posterior wall (9.2%). The results of statistical analysis showed that the plaques were more common in the upper and lower wall of the patients with no infarct. The plaques in the subcortical and subcortical infarcts were more common in the patients with large area infarction and most perforating vessel infarction, and the plaques were located in the superior wall in the patients with no infarct foci. However, there was no significant difference between the two groups (P0.05). Among the 76 plaques included, 53 (69.7%) were male and 23 (30.3%) were female. There was no significant difference between male and female in the distribution of plaque (P0.05). Conclusion: eccentric thickening in patients with MCA stenosis may be associated with unstable plaque, and the location of plaque, especially in the upper wall, may be helpful to judge the type of infarction and to understand the basic mechanism of ischemic events.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R445.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 吳立恒;李天曉;馮廣森;朱良付;王子亮;薛降宇;白衛(wèi)星;賀迎坤;;高分辨率磁共振斑塊成像與DSA評估癥狀性大腦中動脈狹窄的比較[J];中國神經(jīng)精神疾病雜志;2012年05期
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