后循环缺血性卒中颅内动脉粥样硬化的高分辨率磁共振成像特征分析

Intracranial atherosclerosis in ischemic stroke with posterior circulation: a high-resolution magnetic resonance imaging study

目的利用3. 0 T高分辨率MRI探讨后循环缺血性卒中患者的颅内动脉粥样硬化特点。方法回顾性分析于2016年12月至2018年12月河北省人民医院神经内科连续收治的具有后循环缺血症状的21例患者(70个斑块)的颅内动脉粥样硬化影像学及临床特点。将纳入患者依据临床症状、体征及相关影像学表现,分为后循环缺血性卒中组(10例45个斑块)和非卒中组(11例25个斑块)。采集患者完整的临床资料,应用高分辨率全脑三维时间飞跃法MR血管成像评价血管狭窄程度,应用高分辨率T1加权成像轴面计数斑块负荷、斑块强化、斑块高信号、斑块形态等并进行组间比较。结果两组糖尿病患者占比差异有统计学意义(P=0. 024),年龄、性别、吸烟、饮酒、高血压病、高尿酸血症、高脂血症、高同型半胱氨酸症、卒中史、冠状动脉粥样硬化性心脏病史等差异均无统计学意义(均P> 0. 05)。后循环缺血性卒中组斑块负荷高于非卒中组[(4. 5±1. 6)个比(2. 3±1. 6)个;t=3. 190,P=0. 005];两组间斑块强化差异有统计学意义[40. 0%(18/45)比16. 0%(4/25);χ2=4. 295,P=0. 038];两组间斑块高信号、斑块形态差异均无统计学意义(均P>0. 05)。结论后循环缺血性卒中患者糖尿病患者占比较高,颅内动脉粥样硬化斑块负荷及斑块强化较常见,提示后循环缺血性卒中患者斑块易损性较高。

Objective To explore the characteristics of intracranial atherosclerosis and possible pathogenesis of posterior circulation ischaemic stroke by 3.0 T high-resolution magnetic resonance imaging. Methods The imaging and clinical features of intracranial atherosclerosis in 21 patients with posterior ischemic symptoms admitted in the Department of Neurology of Hebei General Hospital from December 2016 to December 2018 were retrospectively analyzed.The recruited patients were divided into the posterior circulation ischemic stroke group(10 cases and 45 plaques) and the non-stroke group(11 cases and 25 plaques )according to their clinical symptoms,signs and imaging manifestations.Clinical data of all patients were collected,and high-resolution 3D time-of-flight MR angiography was used to evaluate the degree of vascular stenosis.Also,plaque characteristics including burden,enhancement,hyperintensity and morphology were counted on high-resolution T1 weighted imaging axial images. Results The The proportion of diabetes was significantly different between the two groups( P =0.024).There were no significant differences in age,sex,smoking,alcohol consumption,hypertension,hyperuricemia,hyperlipidemia,hyperhomocysteinemia,stroke history and history of coronary atherosclerotic heart disease between the two groups(all P >0.05).The plaque burden in the posterior circulation ischemic stroke group was higher than that in the non-stroke group([4.5±1.6] vs .[2.3±1.6])with significant difference( t=3.190,P = 0.005).Plaque enhancement between the two groups was significant different( 40.0%[18/45] vs . 16.0%[4/25],χ 2=4.295, P = 0.038).There was no significant difference in plaque high signal and plaque morphology between the two groups(all P >0.05). Conclusion Patients in the posterior ischemic stroke group had a higher prevalence of diabetes,and intracranial atherosclerotic plaque burden and plaque enhancement were more common,suggesting that the posterior ischemic stroke group had a higher vulnerability of plaque.