皮层下分水岭梗死与腔隙性脑梗死MRI特征及血管相关性对比研究

MRI Features of Subcortical Cerebral Watershed Infarction and Lacunar Infarction and Their Correlation with Vascular Lesions: A Comparative Study

目的研究急性皮层下分水岭梗死与腔隙性脑梗死MRI特征及其与颈动脉系统病变的关系。方法选择DWI病灶符合急性皮层下分水岭梗死42例(A组)和腔隙性脑梗死64例(B组),回顾性分析两组临床和MRI特征及MRA或DSA表现,并进行统计学检验。结果 A组病灶位于深浅穿动脉之间分水岭区,呈"雪茄"状、"串珠"状或卵圆形,病灶体积大;B组病灶多位于基底节区及皮层下,呈圆点状,病灶体积小;A组患者32例(76.2%)有颈动脉系统中重度狭窄或闭塞;B组患者14例(21.9%)存在颈动脉系统中重度狭窄或闭塞,差异有统计学意义(χ2=30.46,P<0.05)。A组患者多表现为非腔隙综合征;B组患者多表现为腔隙综合征,差异有统计学意义(χ2=28,P<0.05)。A组患者较B组患者7天内多见病程进展,预后差(χ2=5.19,P<0.05)。结论皮层下分水岭梗死和腔隙性脑梗死有着不同的MRI特点和病理生理机制,前者多伴有颈动脉系统严重病变,病程进展快,预后差,应积极采取干预措施。

Objective To investigate MRI features of acute subcortical watershed infarction and lacunar infarction, and to analyze their relationship with carotid system lesions. Methods A total of 42 patients with typical acute subcortieal watershed infarction signs on DWI （group A） and 64 patients with lacunar infarction （group B） were enrolled in this study. The MRI characteristics and MRA as well as DSA findings were retrospectively analyzed. Results In group A, the lesions were located in the watershed area between deep and superficial perforating arteries. The lesions were cigar-like, beaded or oval in shape, and usually the lesion volume was large. In group B, the lesions were located at the basal ganglia and subcortical region, presenting as dot in shape, and the lesion volume was small. Moderate to severe stenosis or occlusion of carotid system was detected in 32 patients of group A （76.2%） and in 14 patients of group B （21.9%）, and the difference between the two groups was statistically significant （ χ^2= 30.46, P 〈 0.05 ）. Non-lacunar syndrome was commonly seen in group A, while lacunar syndrome was often seen in group B, and the difference between the two groups was statistically significant （ χ^2= 28 ,P 〈 0.05 ）. Exacerbation of the disease and poorer prognosis within 7 days after the onset of the infarction were more common in group A than in group B （χ^2 = 5.19,P 〈 0.05）. Conclusion Acute subcortical watershed infarction and lacunar infarction have different MRI characteristics and pathophysiological mechanisms. Acute subcortieal watershed infarctions are commonly associated with severe stenosis or occlusion of carotid system, and the exacerbation of the disease and poorer prognosis are often observed. Therefore, for patients with acute subcortical watershed infarction prompt intervention measures should be actively carried out.