高分辨率磁共振评估椎-基底动脉粥样硬化斑块对后循环缺血进展的影响

Effect of evaluation of vertebrobasilar artery atherosclerosis on the progress of posterior circulation ischemia with high-resolution magnetic resonance imaging

目的探讨3.0 T高分辨率磁共振(HR-MRI)评估椎-基底动脉粥样硬化斑块在后循环短暂性脑缺血发作(TIA)病情进展中的价值。方法前瞻性连续纳入2013年7月至2014年7月常熟市第一人民医院神经科门诊及住院的后循环TIA患者30例,均经头部MR血管成像证实存在椎-基底动脉粥样硬化斑块。使用3.0 T HR-MRI对椎-基底动脉斑块进行检查,评估斑块性质及稳定性,根据斑块稳定性结果分为稳定组(16例)与不稳定组(14例)。随访24个月,记录并比较两组患者首次就诊至发生后循环梗死的时间及比例。结果不稳定组发生后循环梗死时间明显短于稳定组,差异有统计学意义[11.5(7.0,20.0)个月比24.0(22.5,24.0)个月,Z=-2.755,P<0.05]。稳定组和不稳定组发生后循环梗死的比例分别为5/16、8/14,组间差异无统计学意义(P>0.05)。结论应用HR-MRI评估椎-基底动脉粥样硬化斑块结果对后循环缺血疾病的进展有一定参考价值。

Objective To investigate the value of evaluating vertebrobasilar artery atherosclerosis with 3. 0 T high-resolution magnetic resonance imaging（ HR-MRI） in the progress of posterior circulation transient cerebral ischemia（ TIA）. Methods From July 2013 to July 2014,30 consecutive patients（ outpatients and inpatients） with posterior circulation TIA at the Department of Neurology,the First People＇s Hospital of Changshu were enrolled respectively. They were all confirmed as the presence of vertebrobasilar atherosclerotic plaques by the head magnetic resonance angiography. The vertebrobasilar artery plaques were examined with 3 T HR-MRI to assess the nature and stability of the plaques. They were randomly divided into either a stable plaque group（ n = 16） or an unstable plaque group（ n = 14） according to the results of plaque stability. They were followed up for 24 months. The time and proportion from the first visit to the posterior circulation infarction were recorded and compared between the two groups of patients. Results At the end of follow-up,the time of posterior circulation infarction in the unstable group was significantly shorter than that in the stable group,and the difference was statistically significant（ 11. 5[7. 0,20. 0]months vs. 24. 0[22. 5,24. 0]months,Z =-2. 755,P 0. 05）. The ratios of posterior circulation infarction in the stable group and the unstable group were 5/16 and 8/14 respectively. The difference was not statistically significant between the two groups（ P 0. 05）. Conclusion Evaluating the results of vertebrobasilar artery atherosclerosis plaque with H R-M RI has a certain value for the progression of posterior circulation ischem ia disease.