大脑前循环短暂性脑缺血发作患者大脑中动脉粥样硬化性狭窄高分辨率磁共振形态学分析

High resolution magnetic resonance morphological analysis of middle cerebral artery atherosclerotic stenosis in patients with transient cerebral ischemic attack

目的通过高分辨率磁共振(HRMRI)技术探究前循环短暂性脑缺血发作(TIA)患者大脑中动脉(MCA)粥样硬化性狭窄最狭窄处的管腔狭窄程度、血管壁面积及管壁重构模式与前循环TIA发生的关系。方法收集2015年1月至2016年1月南阳市中心医院收治的前循环TIA患者93例,均经磁共振血管造影、CT血管造影或数字减影血管造影证实存在MCA粥样硬化性狭窄,根据24 h内TIA发生次数分为频发组(24 h内TIA≥2次)和非频发组(24 h内TIA<2次)。所有患者入院后1周内行HRMRI检查,对比2组患者MCA最狭窄处的管腔狭窄程度、血管壁面积及管壁重构模式。结果 2组患者MCA最狭窄处管腔面积、参考处管腔面积以及血管狭窄程度比较差异均无统计学意义(P>0.05)。2组患者MCA参考处血管壁面积比较差异无统计学意义(P>0.05);频发组患者MCA最狭窄处血管壁面积和血管重构率显著大于非频发组(P<0.001)。结论 MCA血管壁的正性重构生长模式是前循环TIA发生的决定性因素。

Objective To investigate the relationship between the degree of vascular stenosis,stenotic vessel wall area,the remodeling pattern of the vessel wall in the atherosclerotic stenosis site of the middle cerebral artery（ MCA） and the occurrence of anterior circulation transient ischemic attack（ TIA） by high resolution magnetic resonance imaging（ HRMRI）. Methods Ninety-three patients with TIA were selected from January 2015 to January 2016 in Nanyang Central Hospital,and the middle cerebral artery atherosclerotic stenosis was confirmed by magnetic resonance angiography,CT angiography and digital subtraction angiography. The patients were divided into frequent attack group（ TIA≥2 times within 24 h） and non-frequent attack group（ TIA 〈 2 times within 24 h） according to the occurrence frequency of TIA within 24 h. All patients underwent HRMRI examination within one week after admission. The degree of stenosis,vessel wall area and reconstruction of MCA were compared between the two groups. Results There was no significant difference in the area of stenotic vessel,the area of referenced vessel and the degree of stenosis of MCA between the two groups（ P 〉0. 05）. There was no significant difference in the vessel wall area of referenced vessel of MCA between the two groups（ P〉 0. 05）. The vessel wall area and the rate of vascular remodeling in the narrowest part of MCA in the frequent attack group were significantly higher than that in the non-frequent attack group（ P 〈 0. 001）. Conclusion The positive reconstruction of MCA vessel wall is the decisive factor for the occurrence of anterior circulation TIA.