基底动脉粥样硬化性梗死的分类与血管形态学异同的探讨

Vascular pathophysiologic characteristics of different types of basilar atherosclerotic infarction

目的应用高分辨率磁共振(HR-MRI)管壁成像技术研究基底动脉粥样硬化性梗死两种类型——穿支闭塞型病变(BOD)和非穿支闭塞型病变(non-BOD)的血管重构与斑块特征。方法将32例症状性基底动脉狭窄患者分为BOD 18例,non-BOD 14例。应用3.0T HR-MRI对基底动脉进行管壁增强扫描,然后使用CMRtools软件对血管狭窄最严重的层面的管壁及斑块面积等参数进行测量,研究血管的重构和斑块特征。结果 HR-MRI管壁成像结果显示,non-BOD组血管狭窄程度较BOD组更明显[(68.9%±19.1)%vs(43.8%±18.8)%,P=0.017]。正性重构更常见于non-BOD(57.2%vs16.7%,P=0.036)。BOD组管壁面积指数小于non-BOD组(P<0.001)。两组血管强化均以偏心性为主,两组斑块强化比例差异无统计学意义(P=0.196),但BOD组强化程度小于non-BOD组[(39.9±23.2)%vs(65.3±21.1)%,P=0.004]。结论基底动脉BOD梗死和non-BOD型梗死在血管重构和斑块性质方面的特征各不相同。

Objective To use high-resolution magnetic resonance imaging （HR-MRI） for studying the vascular remodeling and plaque characteristics of two types of basilar atherosclerotic infarction branch occlusive disease （BOD） and non-BOD. Methods Thirty-two patients with symptomatic basilar artery stenosis were divided into BOD and non-BOD groups, with 18 patients in BOD group and 14 in non-BOD group. All the patients received 3.0 T HR-MRI enhancement scanning for the basilar artery wall. The wall thickness and plaque area of steno-occlusive basilar artery at the maximal stenosis were measured and analyzed, so as to assess the vascular remodeling and plaque characteristics. Results HR-MRI scanning showed that the stenosis of non-BOD group was more obvious than that of BOD group （[68. 9 ± 19. l]% vs [43. 8±18. 8]%, P = 0.017）. Compared with BOD group, positive remodeling was more frequently observed in non-BOD （57.2% vs 16.7% , P = 0.036）. The wall area index of BOD group was also significantly lower than that of non-BOD group （P〈0.001）. Eccentric enhancement was the main form for the two types of basilar atherosclerotic infarction in study, and the plaque enhancements were not significantly different between BOD and non-BOD groups （P = 0.196） ; however, the enhancement degree of BOD group was significantly milder than that of the non-BOD group （[39. 9 ±23. 2 ]% vs [65. 3 ± 21. P = 0.004）. Conclusion BOD andnon-BOD have different vascular remodelings and plaque characteristics.