基底节区急性脑梗死M1段血管斑块的T1W-3D-VISTA诊断研究

The diagnostic study of T1-weighted 3D volumetric isotropic TSE acquisition in evaluating characteristics of plaques of middle cerebral artery in acute ischemic stroke of basal ganglia

目的利用T1W 3D-VISTA磁共振成像序列对基底节区急性缺血性脑卒中患者大脑中动脉M1段血管斑块分布、信号以及相关临床特点进行分析。材料与方法对MR DWI诊断为大脑中动脉供血区急性缺血性脑卒中的患者行颅内动脉MRA、大脑中动脉T1W 3D-VISTA扫描,根据梗死部位将患者分为基底节组(基底节区/基底节区合并基底节区外脑梗死)和非基底节组(不包含基底节区脑梗死),研究两组患者梗死同侧斑块在M1段血管壁的分布,斑块与胼胝体相对信号强度比值(contrast ratio,CR),以及相关临床特点分析。结果 52例急性大脑中动脉供血区脑梗死伴有同侧中动脉粥样硬化斑块患者(基底节组:30例,非基底节组:22例),一共1560幅图像被研究,其中251幅图像包含斑块,基底节组的上侧壁斑块所占比例(37.74%)较非基底节组(10.26%)大,差异有统计学意义(P=0.004),基底节组的下侧(26.42%)及腹侧(13.21%)斑块所占比例较非基底节组的下侧(48.72%)及腹侧(33.33%)斑块所占比例小,差异有统计学意义(P值分别为0.047,0.039)。基底节组斑块相对信号强度(CR)较非基底节组小(均值分别为0.84,0.92),差异有统计学意义(P=0.001)。两组之间相关临床因素(年龄、性别、高血压、糖尿病、血脂异常、吸烟、饮酒、BMI、入院24 h NIHSS评分、卒中家族史)比较差异无统计学意义(P>0.05)。结论 T1W-3D-VISTA序列可以检测大脑中动脉斑块的分布及相对信号强度,与非基底节区急性脑梗死患者相比,基底节区急性脑梗死患者脑中动脉M1段斑块更多分布于上侧壁,下侧及腹侧壁相对较少,基底节区急性脑梗死患者中动脉斑块相对更稳定。

Objective： To evaluate the characteristics of plaques of middle cerebral artery （MCA） in acute ischemic stroke of basal ganglia using Tl-weighted 3D Volumetric Isotropic TSE Acquisition （T1W 3D-VISTA） and its clinical relevance. Materials and Methods： Patients with acute ischemic stroke of middle cerebral artery territory, which were diagnosed by DWI, underwent both MRA and T1W 3D-VISTA examinations. Patients were divided into two groups according to the distribution of infarction, one contained basal ganglia （BG, basal ganglia/basal ganglia as well as the area outside of it） and the other did not contain basal ganglia （N-BG）. Distribution of blood vessel walls and the contrast ratio （CR） of signal intensity of the plaques to that of the corpus callosum were compared between BG and N-BG and their clinical characteristics were evaluated. Results： Among 52 patients with cerebral infarction and ipsilateral plaques in M1 （BG 30 and N-BG 22）, a total of 1560 image slices were studied. Overall, of the 251 slices with identified plaques, the plaques located at superior wall of BG （37.74%） accounted for a higher proportion as compared with N-BG （10.26%）（P=0.004）, and the plaques located at inferior wall （26.42%） and ventral wall （13.21%） of BG accounted for a lower proportion as compared with the plaques located at inferior wall （48.72%） and ventral wall （33.33%） of N-BG （P=0.047 and 0.039,respectively）. The average signal intensity （CRs） of plaques of BG was lower as compared with plaques of N-BG （mean, 0.84 and 0.92, respectively, P=0.001 ）. The clinical characteristics （including age, gender, hypertension, diabetes, dyslipidemia, smoking, drinking, BMI, NIHSS score within 24 hours after admission, family history of stroke） had no significant difference between BG and N-BG （P〉0.05）. Conclusion： T1W-3D-VISTA can detect the distribution of arterial atherosclerotic plaques and the relative signal intensity. As compared with plaques of N-BG, the plaques of BG are relatively more stable and account for a higher proportion at superior wall and a lower proportion at inferior wall and ventral wall ofMCA MI segment.