不同病因所致脑梗死患者脑白质疏松影像学分析

Imaging analysis of leukoaraiosis in infarction patients of two different causes

目的评价并分析动脉粥样硬化血栓形成和小动脉病变所致脑梗死患者脑白质疏松影像学改变。方法按新TOAST分型,把收集的175例急性脑梗死患者分成动脉粥样硬化血栓形成性、小动脉病变性、心源性、其他原因所致和不明原因脑梗死。同期收集对照组病例50例。采用Fazekas量表,分别对MRI所显示的侧脑室体旁和皮质下白质病变进行评分;根据部位,脑白质疏松分为皮质下型、脑室周围型和混合型三型。比较对照组、动脉粥样硬化血栓形成性脑梗死和小动脉病变性脑梗死所伴发的脑白质疏松的影像学特征。结果动脉粥样硬化血栓形成性脑梗死组59例,其中皮质下型脑白质疏松17例,脑室周围型脑白质疏松1例,混合型脑白质疏松39例。小动脉病变性脑梗死组99例,其中皮质下型脑白质疏松1例,脑室周围型脑白质疏松28例,混合型脑白质疏松66例。两组比较,动脉粥样硬化血栓形成性脑梗死组皮质下型脑白质疏松比例(17/59)高于小动脉病变性脑梗死组(1/99)(P=0.000);小动脉病变性脑梗死组脑室周围型脑白质疏松比例(28/99)高于动脉粥样硬化血栓形成性脑梗死组(1/59)(P=0.000);动脉粥样硬化血栓形成性脑梗死组混合型脑白质疏松比例(39/59)与小动脉病变性脑梗死(66/99)比较无差异(P=0.942)。动脉粥样硬化血栓形成性脑梗死组脑白质疏松评分两侧比较有差别(P=0.019);小动脉病变性脑梗死组脑白质疏松两侧比较无差别(P=0.305);对照组脑白质疏松两侧比较亦无差别(P=1.000)。其他三种病因所致脑梗死病例数少,未予以上归类统计。结论动脉粥样硬化血栓形成性脑梗死和小动脉病变性脑梗死的脑白质疏松以混合型所占比例最高;动脉粥样硬化血栓形成性脑梗死的脑白质疏松以皮层下型为主,并表现为两侧不对称,小动脉病变性脑梗死的脑白质疏松以脑室周围型为主,并表现为两侧对称。

Objective To evaluate and analyze leukoaraiosis imaging changes in infarction patients caused by arterothrombosis and small artery diseases retrospectively.Methods 175 acute cerebral infarction patients were collected,who were subtyped into arterothrombosis,small artery disease,cerebral embolism,some other disease and some unidentified disease according to the new TOAST criteria.Mean while 50 cases were in control group.Leukoaraiosis changed on MRI were rated by the method of Fazekas et al.Leukoaraiosis was divided into three types：subcortical,periventricle and mixed according to the MRI changes.We evaluated and analyzed leukoaraiosis changes in control,arterothrombosis and small artery disease infarction group.Results In 59 arterothrombosis infarction patients,17 patients were divided into subcortical type,39 patients mixed type and 1 patient periventricular type.In 99 small artery disease infarction patients,1 patient was divided into subcortical type,28 patients peripheral type and 66 patients mixed type.The proportion of subcortical type in arterothrombosis infarction group （17/59） was much more than that in small artery disease infarction group （1/99） （P value =0.000）,the difference was statistically significance.The proportion of periventricular type in small artery disease infarction group （28/99） was much more than that in arterothrombosis infarction group （1/59） （P value =0.000）,the difference was statistically significance.There was no difference in the proportion of mixed type between arterothrombosis infarction group （39/ 59） and small artery disease infarction group （66/99） （P value =0.942）.There had significant difference between bilateral leukoaraiosis scores in arterothrombosis infarction group（P value =0.019）.There had no difference between bilateral leukoaraiosis scores in small artery disease infarction group （P value =0.305） and in control group （P =1.000）.Other causes of infarction was not considered for the small sample.Conclusion In arterothrombosis infarction group,the mixed type leukoaraisis take the highest proportion,followed by subcortical type,and the changes are asymmetric.In small artery disease group,the mixed type leukoaraiosis take the highest proportion,followed by periventricular type,and the changes are symmetric.