老年高血压患者脑白质病变在磁共振序列中的半定量评估

Semiquantitative assessment of white matter lesions in elderly hypertensive patients based on magnetic resonance sequences

目的前瞻性分析老年高血压患者脑白质病变(WML)的MRI特征。方法选择2017年4~12月在本院就诊的老年患者80例,依据2017高血压临床诊断指南,将患者分为血压正常组20例和高血压组60例,高血压组又分为血压升高组20例、高血压1级组20例、高血压2级组20例。患者均行头颅T1WI、T2WI、液体衰减反转恢复(FLAIR)序列检查,应用Scheltens视觉评定量表评定患者脑室旁白质评分(0~6分)、深部脑白质评分(0~24分)、基底节白质区评分(0~30分)和幕下白质区评分(0~24分)等,并进行前瞻性分析。结果4组脑室旁白质枕角评分、深部脑白质额叶、顶叶、枕叶和颞叶评分比较,差异均有统计学意义(P<0.05,P<0.01),4组脑室旁白质额角和侧脑室旁评分、基底节白质区和幕下白质区各处评分比较,差异均无统计学意义(P>0.05)。4组脑室旁白质、基底节白质区和幕下白质区评分WML百分率比较,差异无统计学意义(P>0.05),血压正常组、血压升高组、高血压1级组和高血压2级组深部脑白质评分WML百分率比较,差异有统计学意义(16.0%vs 24.6%vs 42.9%vs 49.4%,P=0.001);且血压升高组较血压正常组明显升高;高血压1级组和高血压2级组较血压升高组均明显升高(P=0.01,P=0.03,P=0.02)。高血压2级组较血压正常组脑室旁白质评分WML百分率明显升高(35.0%vs 56.7%,P=0.03)。血压正常组与高血压组脑室旁白质中的枕角评分和深部脑白质评分WML百分率比较,差异有统计学意义(12.5%vs 17.8%,P=0.016;16.0%vs 39.0%,P=0.001)。结论3.0 T MRI FLAIR序列可以半定量评估高血压患者WML进展程度,可为临床提供更有针对性地干预及治疗方案。

Objective To prospectively analyze the MRI characteristics of white matter lesions(WML)in elderly hypertensive patients.Methods Eighty elderly hypertensive patients admitted to our hospital were divided into normal blood pressure group(n=20)and hypertension group(n=60)according to the 2017 guildeline for the clinical diagnosis of hypertention.The 60 patients in hypertension group were further divided into elevated blood pressure group(group A),grade 1 hypertension group(group B)and grade 2 hypertension group(group C),20 in each group and underwent brain T1WI,T2WI and FLAIR.Their periventricular WML,deep WML,basal ganglia WML and subtentorial WML were scored according to the Scheltens vision and prospectively analyzed.Results A significant difference was detected in scores of periventricular occipital angle WML,deep WML,frontal lobe WML,parietal lobe WML,occipital lobe WML and temporal lobe WML(P<0.05,P<0.01)while no significant difference was detected in scores of periventricular frontal angle WML,lateral periventricular WML,basal ganglia WML and subtentorial WML in different groups(P>0.05).The percentage of deep WML score was significantly lower in normal blood pressure group than in group A,group B and group C(16.0%vs 24.6%vs 42.9%vs 49.4%,P=0.001)and in group A than in group B and group C(P<0.05).The percentage of periventricular WML score was significantly lower in normal blood pressure group than in group C(35.0%vs 56.7%,P=0.03).The percentage of periventricular occipital lobe WML and deep periventricular WML was significantly lower in normal blood pressure group than in hypertension group(12.5%vs 17.8%,P=0.016;16.0%vs 39.0%,P=0.001).Conclusion 3.0 T MRI and FLAIR can semiquantitatively assess progressive WML in hypertesive patients and provide reference for working out their intervention and treatment plan.