高分辨率磁共振血管壁成像评估椎-基底动脉硬化血管壁对急性脑梗死患者预后的评估价值

The value of high resolution magnetic resonance angiography in evaluating the prognosis of patients with acute cerebral infarction with vertebrobasilar arteriosclerosis

目的探讨高分辨率磁共振血管壁成像技术评估椎-基底动脉硬化血管壁对急性脑梗死患者预后的评估价值。方法选择2018年12月-2019年9月本院收治的80例急性脑梗死患者,收集患者基本临床资料,对患者头部进行MRI平扫、HRWR-VWI扫描,记录管壁有无增厚及增厚模式、有无斑块及斑块的特点、管腔狭窄程度,测算血管重构指数。结果 80例患者共检测到124处斑块,其中椎动脉斑块48处(38.71%)、基底动脉斑块76处(61.29%)。支配侧管壁增厚程度、斑块表面不规则率、斑块T1高信号率、斑块强化程度、管腔狭窄程度均明显高于非支配侧(P<0.05);89处(71.77%)血管发生正性重构,35处(28.23%)血管发生负性重构。正性重构血管的RI值明显高于负性重构血管(1.32±0.18 vs. 0.77±0.17,P=0.001),参考层面的血管面积、管壁面积、管腔面积均无明显差异(P>0.05);正性重构血管的斑块负荷、斑块面积、最窄层面的血管面积、管壁面积、管腔面积均明显大于负性重构血管(P<0.05)。结论急性脑梗死的发生与椎-基底动脉硬化血管壁的狭窄程度、管壁的增厚模式、粥样硬化斑块的强化模式、血管重构情况有关,HRWR-VWI技术可清晰地检测上述指标,有助于急性脑梗死的发病及预后水平的判断。

Objective To investigate the prognostic value of HRWR-VWI in evaluating vertebral-basilar arteriosclerosis vessel wall in patients with acute cerebral infarction.Methods 80 patients with acute cerebral infarction admitted to our hospital from January 2017 to December 2018 were selected for the study. Basic clinical data of the patients were collected, and MRI plain scan and HRWR-VWI scan were performed on the head of the patients. The thickness and thickening pattern of the wall, the presence and characteristics of plaque, and the stenosis degree of the lumen were recorded, and the vascular remodeling parameters were measured.Results A total of 124 plaques were detected in 80 patients, including 48 vertebral artery plaques(38.71%) and 76 basilar artery plaques(61.29%). The thickening degree of the wall of the dominant side, the irregular rate of plaque surface, the high signal rate of T1, the plaque enhancement degree and the degree of lumen stenosis were significantly higher than those of the non-dominant side(P<0.05). There were 89(71.77%) positive angiogenesis and 35(28.23%) negative angiogenesis. The RI value of the positive vessel remodeling was significantly higher than that of the negative vessel remodeling(1.32±0.18 vs. 0.77±0.17, P=0.001), and there were no significant differences in vessel area, wall area and lumen area among the reference levels(P>0.05). The plaque load, plaque area, vascular area at the narrowest layer, wall area and lumen area of the positive remodeling vessels were significantly larger than those of the negative remodeling vessels(P<0.05).Conclusion The occurrence of acute cerebral infarction was related to the stenosis degree of vertebral basilar atherosclerosis vessel wall, the thickening pattern of vessel wall, the enhancement pattern of atherosclerotic plaque, and the vascular remodeling. The HRWR-VWI technology could clearly detect the above indicators, which was helpful for the judgment of the incidence and prognosis level of acute cerebral infarction.