3D-TOF MRA对大脑中动脉闭塞后侧枝循环及其与脑梗死相关性的研究

Collateral Circulation and Its Correlation with Ischemic Stroke at 3D-TOF MRA after Middle Cerebral Artery Occlusion

目的探讨3D-TOFMRA评价大脑中动脉闭塞后脑部侧枝循环的作用,并研究3D-TOFMRA所评估的侧枝循环状况与脑梗死大小之间的相关性。方法回顾性分析34例大脑中动脉闭塞组与36例健康对照组的3D-TOFMRA和MRI(T1WI、T2WI)。统计大脑中动脉闭塞组来自病变同侧大脑后动脉(PCA)和大脑前动脉(ACA)软脑膜血管吻合(LMA)代偿的间接征象,即病变同侧PCA、ACA偏利现象(与对侧相比血管增粗,分支增多、延长)的出现频率,并与对照组进行比较分析。同时记录34例大脑中动脉闭塞患者PCA、ACA偏利现象的评分及脑梗死的大小,对脑梗死大小分组并进行组间比较分析。结果病例组病变同侧PCA、ACA偏利现象的出现频率明显高于对照组(P<0.01)。不同脑梗死灶大小组间PCA、ACA偏利现象的评分差异均有统计学意义(PCA,P<0.01;ACA,P<0.01或P<0.05),梗死灶由小到大其偏利现象的评分依次降低。结论大脑中动脉闭塞后,3D-TOFMRA可以通过观察病变同侧PCA、ACA的偏利现象间接评价来自PCA、ACA的LMA侧枝循环状况。3D-TOFMRA所评估的LMA代偿状况与脑梗死大小有密切相关性。3D-TOFMRA对临床诊治及预后大脑中动脉闭塞患者有重要指导意义。

Objective To investigate the role of 3D-TOF MRA in evaluation of cerebral collateral circulation after middle cerebral artery （MCA） occlusion, and analyze its correlation with ischemic stroke. Methods The 3D-TOF MRA and MRI（T1W1,T2W1） findings were retrospectively reviewed in 34 patients with middle cerebral artery occlusion and 36 healthy control subjects. Frequency of posterior cerebral artery （PCA） and anterior cerebral artery （ACA） laterality at 3D-TOF MRA in patients and that in healthy control subjects were compared. The PCA and ACA laterality represents the existence of collateral circulation from the PCA and ACA via the leptomeningeal anastomosis （LMA）. Meanwhile, the laterality of PCA and ACA were scored, and the cerebral infarct size was recorded, then divided them into three groups according to the infarct size, and the groups were compared with each other. Results Frequency of PCA and ACA laterality in patients are much higher than that in healthy control subjects （P〈0.01）. There are statistic differences between scores of PCA and ACA laterality of each two infarct size group（ PCA,P〈0.01 ; ACA, P〈0. 01 or P〈0.05）. Conclusion After MCA occlusion, the laterality of PCA and ACA at 3D- TOF MRA can be used to evaluate the collateral circulation from the PCA and ACA via the LMA. The LMA evaluated at 3D-TOF MRA is significantly associated with cerebral infarct size. 3D-TOF MRA might play a important role in diagnosis, treatment and prognosis after MCA occlusion.