大脑中动脉支配区急性脑梗死的弥散加权成像病损分型的意义

Specific DWI Lesion Patterns of Acute Ischaemic Stroke Within the MCA Territory

目的：大脑中动脉（MCA）支配区脑梗死的分型与发病机制尚不明确。本研究对MCA支配区急性脑梗死（AIS）患者进行弥散加权成像（DW1）检查，根据DWI结果对AIS分型与其机制进行相关性研究。方法：本研究选择MCA支配区的AIS患者，对所有人选患者进行DWI与磁共振血管造影（MRA）检查并评价DWI病灶特点及MCA病变。AIS的DWI病损分为6型：①大面积脑梗死；②其它皮层梗死；③皮层小梗死；④内侧分水岭区梗死；⑤深部小梗死；⑥其它深部梗死。结果：人选本研究的MCA支配区的AIS患者共129名。DWI亚型中最多见的是皮层小梗死（44／129，34．1％），且皮层小梗死的MCA狭窄病变较其它亚型最常见（25／34，56．8％）。大面积脑梗死亚型的MCA闭塞病变较常见（7／12，58．3％）。结论：本研究结果DWI病损分型与MCA支配区AIS的病因存在相关性。DWI病损分型可对明确AIS病因提供线索。

OBJECTIVE： To identify lesion patterns and mechanisms of acute ischaemic stroke （AIS） within MCA territory using early diffusion-weighted imaging （DWI）. METHODS： The patients with acute infarcts within MCA territory were enrolled. Brain DWI was obtained and magnetic resonance angiography （MRA） was can＇ied out to evaluate the infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into six categories ： ①territorial infarcts, ②other cortical infarcts, ③small su-perficial infarcts, ④internal border zone infarcts, ⑤small deep infarcts, ⑥other deep infarcts. RESULTS： A total of 129 patients with acute cerebral infarcts within MCA territory were recruited. The most common DWI lesion patterns was small superficial infarcts （44/129, 34. 1% ）. MCA stenosis were more common in patients wifh small superficial infarcts than in those with other lesion pat-terns （25/34, 56. 8% ）. Territorial infarcts were identified more often in patients with occlusion of MCA （7/12, 58.3% ）. CONCLUSION： The results of this study suggest that specific distributions of types of lesion, as evaluated by DWI, are associated with specific stroke etiologies in acute MCA infarction. Identification of DWI lesion distribution may provide early clues as to stroke etiologies.