急性脑梗死散在和单一弥散加权成像病损与其供血动脉狭窄的关系

Study of relationship between scattered or single lesion on diffusion-weighted imaging and arterial stenosis in acute cerebral infarction

目的探讨急性脑梗死弥散加权磁共振成像（DWI）上大脑中动脉（MCA）供血区散在性或单一性缺血性病损与其脑供血动脉狭窄或闭塞的关系。方法回顾性分析73例连续积累的DWI显示一侧MCA供血区脑梗死的病例，入组病例均排除心源性栓塞性脑梗死，所有患者均在发病24h内进行MRI和MRA等检查，7例患者并进行DSA。采用DWI急性缺血性病损分类方法分为散在病损组和单一病损组，比较两组的病灶同侧MCA、颈内动脉（ICA）颅内段和颅外段狭窄或闭塞的发生率。结果散在病损组42例，单一病损组31例。在病损同侧ICA颅外段和MCA闭塞或重度狭窄方面两组差异有统计学意义（28．6％与0，x2=10．6，P=0．001）。在病损同侧ICA颅内段并MCA轻中度狭窄方面，两组间差异具有统计学意义（31．0％与9．7％，X2=4．717，P=0．03）。散在病损与MCA和（或）ICA严重或多发狭窄呈正相关（OR值为13．7，95％CI：3．6—52．5）。在MRA或DSA未发现颅内外大血管狭窄方面，两组问差异具有统计学意义（11．9％与32．3％，X2=4．526，P=0．033）。散在病损组与无明显血管狭窄呈负相关（OR值为0．284，95％CI：0．09～0．94）。结论（1）脑梗死急性期DWI显示的MCA区散在性病损患者，MCA和ICA狭窄、甚至闭塞的可能性较大，以ICA颅外段闭塞较为常见；（2）DWI显示单一病损时提示脑供血动脉狭窄程度较轻，范围较局限，小血管病变的可能性相对较高，很少为严重的ICA颅外段狭窄或闭塞。

Objective To investigate the relationship between scattered or single lesion of acute cerebral infarction in middle cerebral artery territory on diffusion-weighted imaging （DWI） and stenosis of middle cerebral artery （MCA） or internal carotid artery （ICA）. Methods With exclusion of cardioembolism, 73 consecutive patients with acute cerebral infarction of the unilateral MCA territory on DWI were analyzed. All patients got magnetic resonance imaging （MRI） and angiography （MRA） within 24 hours after onset, and 7 patients also had digital subtraction angiography （DSA）. The patients were classified into single lesion group or scattered lesions group according to the DWI findings. The incidence of stenosis or occlusion of ipsolateral MCA, intracranial and extracranial ICA were compared between the two groups. Results 42 patients had scattered lesions and 31 patients had single lesion. The scattered-lesions group had a high incidence of ipsilateral extracranial ICA or MCA occlusion or severe stenosis （ 28. 6% versus 0, X2 = 10. 6, P = 0. 001 ） and a high incidence of ipsilateral intracranial ICA or MCA moderate or mild stenosis （31.0% versus 9. 7% ,X2 =4. 717, P =0. 03）. A positive correlation was found between the scattered lesions and severe or multifocal stenosis of ipsilateral ICA and MCA （OR： 13.7, 95% CI： 3.6 to 52. 5）. There was a low incidence of absence of extra- and intracranial stenosis on MRA or DSA in the scattered-lesions group （11.9% versus 32. 3% ,X2 =4. 526, P =0. 033）. A negative correlation was found between the scattered lesions and absence of large-artery stenosis （OR： 0. 284, 95% CI： 0. 09 to 0.94）. Conclusions （1）Patients with acute cerebral infarction and scattered lesions on DWI were more likely to suffer from stenosis or occlusion of ICA or MCA, especially over the extracranial ICA. （2） Patients with single lesion were less likely to have severe or multiple stennsis of MCA and ICA, indicating the relevance ofsmall-vessel pathogenesis.