急性缺血性脑血管病患者颅内动脉钙化与脑小血管病MRI特征性表现的相关性研究

Correlation analysis between intracranial arterial calcification and cerebral small vessel disease in patients with acute ischemic cerebro vascular disease

目的:探讨急性缺血性脑血管病患者颅内动脉钙化的分布规律及其与脑小血管病(CSVD)的关系。方法:回顾性分析行CTA和MRI检查的276例急性缺血性脑血管病患者的相关资料。采用Agatston法计算颅内动脉钙化积分;MRI评价CSVD影像表现,包括脑梗死、脑白质高信号(WMH)、腔隙灶、脑微出血和血管周围间隙扩大(EPVS)。结果:276例中,颅内动脉钙化200例(72.5%)。颅内动脉钙化程度与WMH、腔隙灶及脑微出血均相关(均P<0.001),而与EPVS无明显相关(P=0.058),相关系数(rs)分别为0.350、0.285、0.251和0.142。颅内动脉钙化与CSVD的MRI表现相关性的优势比及95%置信区间(95%CI):WMH 1~2级为4.9(2.5,9.2),WMH 3级为6.6(3.1,14.1);腔隙灶为3.5(1.9,6.2);脑微出血为2.6(1.5,4.5);EPVS 1级为1.6(0.9,3.0),EPVS 2~4级为1.7(0.8,3.6)。结论:急性缺血性脑血管病患者颅内动脉钙化发生率较高,以颈内动脉为著。颅内动脉钙化程度与WMH、腔隙灶及脑微出血显著相关,可作为CSVD预测指标,具有一定临床价值。

Objective:To investigate the distribution pattern of intracranial arterial calcification and its association with neuroimaging markers of cerebral small vessel disease(CSVD) in patients with acute ischemic cerebrovascular disease.Methods:276 patients with acute ischemic cerebrovascular disease who underwent both CTA and MRI were enrolled in this study.Intracranial arterial calcium scores were evaluated by Agatston method.MRI was performed to detect and evaluat the severity of the CSVD imaging markers,including cerebral infarction,white matter hyperintensity(WMH),lacunes,cerebral microbleeds,and enlarged perivascular space(EPVS).Results:Intracranial artery calcification was detected in 200(72.5%) cases.The severity of intracranial arterial calcification was correlated with WMH,lacunes,and cerebral microbleeds(all P <0.001),however,there was no association between calcifications and EPVS(P =0.058);and the correlation coefficients were 0.350,0.142,0.285 and0.251 for WMH,EPVS,lacunes,and cerebral microbleeds,respectively.The odds ratios(ORs) and 95%CI of intracranial arterial calcification were as follows:WMH Grade 1~2 of 4.9(2.5,9.2),WMH Grade 3 of 6.6(3.1,14.1),lacunes of 3.5(1.9,6.2),cerebral microbleeds of 2.6(1.5,4.5),EPVS Grade 1 of 1.6(0.9,3.0),and EPVS Grade 2~4 of 1.7(0.8,3.6).Conclusions:Intracranial artery calcification is common in patients with ischemic cerebrovascular disease and the internal cartoid artery is most frequently affected.Intracranial arterial calcifications might be associated with neuroimaging markers of CSVD and are highly correlated with WMH,lacunes,and cerebral microbleeds.Intracranial arterial calcification could act as a potential marker of CSVD.