成人烟雾病患者不同分期脑内缺血性病变MRI特点

The MRI features of ischemic lesions of adult moyamoya disease patients in different stage

目的分析不同分期烟雾病患者脑内缺血性病变磁共振成像(magnetic resonance imaging,MRI)特点及可能的发病机制。材料与方法回顾性分析94例成人烟雾病患者174侧受累大脑半球脑内缺血病灶分布特点,进行脑血管意外(cerebrovascular accident,CVA)评分,并比较其与数字减影血管造影(digital subtraction angiography,DSA)分期的相关性。结果174侧受累大脑半球Ⅰ期6侧,Ⅱ期26侧,Ⅲ期23侧,Ⅳ期50侧,Ⅴ期49侧,Ⅵ期20侧;其中156侧大脑半球出现缺血病灶,114侧大脑半球缺血病灶仅累及皮层下组织,42侧大脑半球缺血病灶累及皮层,145侧大脑半球缺血灶仅累及前循环,11侧大脑半球缺血病灶累及后循环;174侧受累大脑半球CVA评分0分18侧,1分74侧,2分40侧,3分42侧。随着血管造影分期的进展,脑内缺血病灶由皮层下区域逐渐累及皮层(r=0.32859,P<0.0001),且缺血病灶CVA评分逐渐增加(r=0.30375,P<0.0001)。结论成人烟雾病患者脑内缺血病灶的分布模式和病灶大小随着病情进展有一定的变化规律,了解该特点对烟雾病的早期诊断及病情评估有一定的临床价值。

Objective： To analyze the MRI features of adult moyamoya patients in different stage and possible pathogenesis. Materials and Methods： We retrospectively reviewed the topography of ischemic lesions in 174 cerebral hemispheres of 94 adult patients with moyamoya disease, CVA score were calculated and its correlation with DSA fi ndings were compared. Results： Using the results of DSA as reference, there were 6, 26, 23, 50, 49, 20 cerebral hemispheres in stages I to VI respectively among all 174 cerebral hemispheres. Ischemic lesions were detected in 156 hemispheres： 114 hemispheres only effect sub-cortical structure and 42 hemispheres has cortical areas been involved. There are 145 hemispheres that have lesions located in anterior circulation and 11 hemispheres has lesions in posterior circulation areas. The number of hemispheres whose CVA score is 0-3 are 18, 74, 40, 42 respectively. Along with the increase of stages diagnosed by DSA, the lesions growth from sub-cortical area to cortical area（r=0.32859, P〈0.0001）, while the CVA score increased as well（r=0.30375, P〈0.0001）. Conclusion： The location and size of ischemic lesions in patients with moyamoya disease changes along with the progress of DSA grade, which would behelpful to early diagnosis and condition evaluation.