深穿支动脉和浅表穿支动脉供血区梗死病人颅内动脉管壁特征的高分辨力MRI研究

Evaluation of the intracranial vessel wall characteristics in deep perforator and superficial perforator infarcts using high resolution magnetic resonance imaging

目的应用全脑高分辨MRI(HRMRI)技术比较分析大脑中动脉浅表穿支动脉区梗死(SPI)和深穿支动脉区梗死(DPI)病人的颅内动脉管壁特征,以阐述其潜在的发病机制。方法回顾性分析41例[男31例,女10例;平均年龄(51.9±11.33)岁]急性期SPI和DPI行全脑HRMRI检查的病人,HRMRI采用优化的3D可变翻转角度快速自旋回波T1加权(3D T1SPACE)序列。分析梗死供血区血管动脉粥样硬化斑块的存在情况,分别测量斑块最狭窄层面的狭窄程度、重构指数以及斑块强化情况;计量资料的组间比较采用t检验或Mann-Whitney U检验,计数资料的组间比较采用χ2检验,P<0.05为差异有统计学意义。结果 41例病人中,SPI 14例(34.1%),DPI27(65.9%)例。SPI组中,共13例(92.9%)病人存在颅内动脉粥样硬化斑块,DPI组有15例(55.6%),SPI病人颅内动脉粥样硬化斑块的发生率高于DPI病人(P=0.038);SPI病人管腔狭窄程度大于DPI病人(71.20%±29.46%和44.01%±28.24%,P=0.019),两组间重构指数和斑块强化情况无统计学差异(P=0.865,0.538)。结论 DPI可能由小血管疾病或载体动脉斑块堵塞穿支引起,而SPI主要由大动脉粥样硬化疾病引起,这两种梗死模式具有不同的管腔狭窄程度。

Objective To investigate intracranial vessel wall characteristics between superficial perforator infarction（SPI） and deep perforator infarction（DPI） by using whole-brain high-resolution magnetic resonance imaging（HRMRI）, and to clarify their underlying pathogenesis. Methods Forty-one patients（31 male, 10 female; mean age, 51.9 years ±11.33）with recent SPI or DPI were retrospectively enrolled and whole-brain HRMRI was performed. HRMRI protocol included a 3D T1 weighted technique known as inversion-recovery（ IR） prepared SPACE. The presence of intracranial atherosclerotic plaque within the responsible vessels, stenosis degree, remodeling index（RI）, and plaque enhancement at the most stenotic site of intracranial atheroma were analyzed. Differences between two groups were then assessed using t-test or Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. A P-value of less than 0.05 indicated statis tical significance. Results Fourteen of 41（34.1%） were patients with SPI and 27（65.9%） were patients wtih DPI. HRMRI detected intracranial atherosclerotic plaques in 13（92.9%） of 14 patients with SPI and 15（55.6%） of 27 patients with DPI.The occurrence of intracranial large-vessel atherosclerotic plaques was greater in the SPI group than in the DPI group（P=0.038）. Patients with SPI had severer stenosis degree than patients with DPI（71.20%±29.46% vs. 44.01%±28.24%; P=0.019）. The RI and plaque enhancement did not differ between the two groups（P=0.865, 0.538, respectively）. Conclusions Small vessel disease or parental artery plaques blocking orifice of the perforating artery may be the reason of DPI. Whereaslarge-vessel atherosclerotic disease may be the main reason of SPI. These two types of infarction have different vascular pathophysiologies in terms of stenosis degree.