大脑中动脉水平段重度狭窄患者斑块特征及其与脑梗死的相关性分析

Plaque Characteristics in Patients with Severe Stenosis of Middle Cerebral Artery and Its Correlation with Cerebral Infarction

背景斑块不稳定是导致缺血性脑卒中的主要原因,而斑块内出血又是导致斑块不稳定的主要原因,故早期发现斑块内出血对早期预防缺血性脑卒中具有重要意义。目的基于3D快速黑血管壁磁共振成像(3D T1-SPACE)技术,分析大脑中动脉水平段重度狭窄患者斑块特征及其与脑梗死的相关性。方法选取2018年3月—2019年1月河北医科大学第四医院神经内科门诊和住院部收治的大脑中动脉水平段重度狭窄患者50例,经弥散加权成像(DWI)序列判定为脑梗死38例(脑梗死组)、非脑梗死12例(非脑梗死组)。在大脑中动脉水平段狭窄部位进行3D T1-SPACE,以其序列上出现高信号判定为斑块内出血。比较两组患者脑梗死危险因素(主要包括性别、年龄、吸烟情况、饮酒情况及高血压、糖尿病发生情况);分析本组患者斑块位置及形状;比较两组患者斑块内出血发生率。结果3D T1-SPACE序列显示,本组患者中斑块位于MCA M1段者42例(占84.0%),位于MCA M2段者8例(占16.0%);斑块呈偏心形40例(占80.0%),呈环形10例(占20.0%)。脑梗死组患者斑块内出血发生率高于非脑梗死组(P<0.001)。结论3D T1-SPACE序列显示,大脑中动脉水平段重度狭窄患者斑块主要位于M1段,多呈偏心形,且斑块内出血与脑梗死发生有关,故3D T1-SPACE技术可作为预防脑梗死的影像学检查手段。

Background Plaque instability is the main cause of ischemic stroke,and plaque hemorrhage is the main cause of plaque instability,so early detection of plaque hemorrhage is of great significance for early prevention of ischemic stroke.Objective Based on 3D T1-SPACE technology,to analyze the plaque characteristics in patients with severe stenosis of middle cerebral artery and its correlation with cerebral infarction.Methods 50 patients with severe stenosis of middle cerebral artery in outpatient and inpatient Department of Neurology,the Fourth Hospital of Hebei Medical University from March 2018 to January 2019 were selected,they were divided into cerebral infarction group(n=38)and non-cerebral infarction group(n=12)according to DWI sequence examination results.3D T1-SPACE was performed at the stenosis site of middle cerebral artery,and it was judged as intracoronary hemorrhage according to the high signal on the sequence.The risk factors of cerebral infarction(mainly including gender,age,smoking,drinking,hypertension and diabetes)were compared between the two groups;the plaque location and shape were analyzed;the incidence of plaque hemorrhage was compared between the two groups.Results 3D T1-SPACE sequence showed that,42 cases(84.0%)were located in M1 segment of MCA,8 cases(16.0%)were located in M2 segment of MCA.The plaque was eccentric shape in 40 cases(80.0%)and annular shape in 10 cases(20.0%).The incidence of plaque hemorrhage in cerebral infarction group was higher than that in non-cerebral infarction group(P<0.001).Conclusion 3D T1-SPACE sequence showed that,the plaque in patients with severe stenosis of middle cerebral artery is mainly located in M1 segment,most of them are eccentric shape,and plaque hemorrhage is related to the cerebral infarction.Therefore,3D T1-SPACE technique can be used as an imaging method to prevent cerebral infarction.