缺血型烟雾病与出血型烟雾病高分辨率磁共振成像特点的比较

Comparison of the high resolution magnetic resonance imaging characteristics between ischemic moyamoya disease and hemorrhagic moyamoya disease

目的比较缺血型烟雾病(MMD)和出血型MMD高分辨率磁共振成像(HR-MRI)的特点。方法选取2017年10月至2018年10月郑州大学第一附属医院收治的MMD患者,将患者分为缺血型MMD组和出血型MMD组。比较两组患者的一般资料、双侧大脑中动脉HR-MRI图像特点,借助数字减影血管造影(DSA)图像分析每侧半球颅底烟雾血管的Suzuki分期,并进行一致性检验。结果共纳入51例MMD患者,分为缺血型MMD组(36例)和出血型MMD组(15例)。缺血型MMD组性别、年龄、高血压病史、糖尿病史、总胆固醇、甘油三酯、HDL、纤维蛋白原分别与出血型MMD组比较,差异无统计学意义(均P>0.05)。缺血型MMD组LDL水平低于出血型MMD组,差异有统计学意义(P<0.05)。缺血型MMD组管壁向心性增厚比例与出血型MMD组比较,差异无统计学意义(P>0.05)。缺血型MMD组增强后延迟期管壁强化比例高于出血型MMD组,差异有统计学意义(P<0.05)。MMD患者DSASuzuki分期组间和组内一致性较好(Kappa=0.900、0.967,P<0.001)。双侧大脑中动脉高分辨率磁共振血管壁增厚方式组间和组内一致性较好(Kappa=0.909、0.977,P<0.001)。双侧大脑中动脉高分辨率磁共振血增强后延迟期管壁强化级别组间和组内一致性较好(Kappa=0.896、0.979,P<0.001)。结论缺血型MMD和出血型MMD的HR-MRI特点不同。缺血型MMD增强后延迟期管壁多强化,而出血型MMD增强后延迟期管壁多无强化。

Objective To compare the high resolution magnetic resonance imaging (HR-MRI) characteristics between ischemic moyamoya disease and hemorrhagic moyamoya disease. Methods Patients diagnosed with MMD in the First Affiliated Hospital of Zhengzhou University from October 2017 to October 2018 were enrolled.The patients were divided into ischemic MMD group and hemorrhagic MMD group.The general clinical data and HR-MRI features of the bilateral middle cerebral artery in the two groups were compared,and the Suzuki staging of all patients were based on digital subtraction angiography (DSA),and then conduct consistency check. Results A total of 51 patients with moyamoya disease were included,dividing into ischemic MMD group (36 cases) and hemorrhagic MMD group (15 cases).There were no significant differences in gender,age,history of hypertension,history of diabetes,total cholesterol,triglyceride,HDL and fibrinogen between the ischemic MMD group and the hemorrhagic MMD group (all P > 0.05).The level of LDL in the ischemic MMD group was lower than that in the hemorrhagic MMD group,and the difference was statistically significant ( P < 0.05).There was no significant difference in the proportion of concentric thickening between the ischemic MMD group and the hemorrhagic MMD group ( P > 0.05).The proportion of wall enhancement in the ischemic MMD group was higher than that in the hemorrhagic MMD group,and the difference was statistically significant ( P < 0.05).The inter-group and intra-group agreement of the DSA Suzuki staging in MMD pateints was excellent (Kappa=0.900,0.967, P < 0.001).The inter-group and intra-group agreement of high-resolution magnetic resonance vessel wall thickening in the bilateral middle cerebral artery was excellent (Kappa=0.909,0.977, P < 0.001).The inter-group and intra-group agreement of the bilateral middle cerebral artery high-resolution magnetic resonance vessel wall enhancement grades was also excellent (Kappa=0.896,0.979, P < 0.001). Conclusion The characteristics of HR-MRI between ischemic MMD and hemorrhagic MMD are different.The wall of ischemic MMD is more strengthened in delayed phase after enhancement,while the wall of hemorrhagic MMD is more unreinforced in delayed phase after enhancement.