小脑分水岭梗死的临床和影像学分析

Clinical and imaging analysis of cerebellar watershed infarction

目的探讨小脑分水岭梗死患者血管病变特点。方法收集178例小脑梗死病例的临床表现及磁共振成像（MRI）、磁共振弥散加权成像（DWI）、磁共振血管造影（MRA）／CT血管造影（CTA）检查结果，按DWI上病灶部位分为小脑分水岭梗死和非分水岭梗死。根据MRA／CTA检查结果将椎一基底动脉狭窄部位分为四种类型：颅内段、颅外段、混合性和未发现狭窄，比较小脑分水岭梗死和非分水岭梗死患者血管病变的特点。结果178例患者中42例符合小脑分水岭梗死；小脑分水岭梗死患者起病时症状较轻，预后良好，但血管狭窄发生率为90．5％，高于小脑非分水岭梗死（74．3％）；颅内段、颅外段、混合性、未发现狭窄4种血管病变类型在小脑分水岭梗死患者中分别占14．3％，52．4％，23．8％，9．5％，在小脑非分水岭梗死中则分别为33．8％，16．2％，24.3％，25．7％。结论尽管小脑分水岭梗死患者有着更为良性的临床表现和预后，但大血管狭窄，尤其是椎动脉颅外段狭窄的发生率高，应早期进行血管内干预治疗。

Objective To investigate the characteristics of arterial stenosis in patients with cerebellar watershed infarction. Methods The clinical data, including clinical manifestation, magnetic resonance imaging （MRI）, diffusion weighted imaging （DWI） and magnetic resonance angiography （MRA） / computerized tomographic angiography （CTA）, of 178 cerebellar infarction cases were collected. According to lesion location on DWI, 178 cases were divided into cerebellar watershed infarction group and non-watershed infarction group. According to location of stenosis in MRA/CTA, vertebrobasilar artery stenosis can be divided into 4 types： intracranial, extracranial, combined, and not detected stenosis. The features of stenosis were compared between cerebellar watershed infarction and non-watershed infarction. Results Among the 128 cases, 42 met the diagnosis of cerebellar watershed infarction. The cerebellar watershed infarction cases had mild clinical features and benign prognosis. However, they had a higher incidence of stenosis （90.5%） than non-watershed infarction cases （74.3%）. Intracranial, extracranial, combined, and not detected stenosis represented 14.3%, 52.4%, 23.8%, 9.5% in 42 cerebellar watershed infarction cases, and 33.8%, 16.2%, 24.3%, 25.7% in cerebellar non-watershed infarction. Conclusion Although cerebellar watershed infarction patients had more benign clinical features and prognosis, they had a higher incidence of large diameter arteries stenosis, especially stenosis in extracranial arteries and early endovascular treatment should be administrated.