老年人脑白质高信号与磁共振液体反转序列高信号血管征的相关性研究

Relationship between white matter hyperintensities and hyperintense vessel sign on fluid-attenuated inversion recvery magnetic resonance imaging in older adults

目的研究老年人脑白质高信号（WMH）与磁共振液体反转序列（FLAIR）颅内高信号血管征（HVS）的相关性，探讨WMH的危险因素及发病机制。方法回顾性收集了2013—2016年期间在我院一月内行头颈部计算机断层血管造影（CTA）和头颅MRI检查患者的影像和临床资料，采用Fazekas视觉量表分别对两侧大脑半球侧脑室旁白质（PWMH）和皮层下深部白质（DWMH）进行评估；根据大脑半球是否出现HVS分为HVS阳性和阴性两组，比较两组的临床资料、PWMH和DWMH差异。结果本研究共纳入271例患者即542侧大脑半球，其中HVS阳性79侧（14.6%）、阴性463侧（85.4%）。HVS阳性和阴性两组在同侧颈内动脉（ICA）的狭窄程度上差异有统计学意义（χ2＝126.840，P〈0.01），HVS阳性同侧ICA重度狭窄的发生率62.0%（49/79）明显高于HVS阴性侧9.9%（46/463）。HVS阳性侧中重度DWMH的发生率为65.8%（52/79），HVS阴性侧为34.8%（161/463），差异有统计学意义（χ2＝34.962，P〈0.01）。而中重度PWMH的发生率在两组分别为65.8%（52/79）、55.5%（257/463），差异无统计学意义（χ2＝6.944，P＝0.074）。多项Logistic回归分析显示在调整年龄、性别、同侧ICA狭窄程度及高血压、糖尿病等基础疾病后，HVS阳性仍是DWMH的独立危险因素（OR＝ 2.653，95%CI：1.489～4.726，P＝0.001）。结论HVS阳性是老年人DWMH的独立危险因素，而与PWMH并无明确相关性，提示脑内低灌注状态是老年人DWMH的可能发病机制。

ObjectiveTo investigate the correlation between white matter hyperintensities（WMH）and hyperintense vessel sign（HVS）on fluid-attenuated inversion recovery（FLAIR）magnetic resonance imaging（MRI）in old adults and to explore the risk factors and pathogeneses of WMH.MethodsWe retrospectively collected imaging and clinical data of patients who had received both head and neck CTA and brain MRI within one month at our hospital from 2013 to 2016.The Fazekas visual scale was used to evaluate periventricular white matter hyperintensity（PWMH）and deep white matter hyperintensity（DWMH）in each brain hemisphere.According to the presence or absence of HVS in a cerebral hemisphere, patients were assigned into an HVS-positive group or an HVS-negative group.Clinical data, PWMH, and DWMH differences were compared between the two groups.ResultsA total of 271 patients（542 cerebral hemispheres）were included in this study.HVS-positive imaging occurred in 79（14.6%）cerebral hemispheres and negative imaging was observed in 463（85.4%）cerebral hemispheres.There was a significant difference between the HVS-positive and negative groups in the ipsilateral CIA stenosis（χ2=126.840, P〈0.01）. The incidence of ipsilateral severe carotid artery stenosis in the HVS-positive group was 62.0%（49/79）, which was significantly higher than 9.9%（46/463）in the HVS-negative group.The incidence of moderate-severe DWMH was 65.8%（52/79）in the HVS-positive group, which was higher than 34.8%（161/463）in the negative group（χ2=34.962, P〈0.01）. Nevertheless, the incidences of moderate-severe PWMH in the two groups were 65.8%（52/79）and 55.5%（257/463）, respectively, without a significant difference between them（χ2=6.944, P=0.074）. After adjusting for age, gender, ipsilateral ICA stenosis, hypertension, diabetes, etc.multivariate analysis suggested that HVS-positive imaging was still an independent risk factor for DWMH（OR=2.653, 95%CI： 1.489-4.726, P=0.001）.ConclusionsHVS-positive imaging is an independent risk factor for DWMH in the elderly, but no clear correlation with PWMH is found.It suggests that hypoperfusion is a possible mechanism for the development of DWMH in the elderly.