基于3.0T高分辨率磁共振成像观察大脑中动脉狭窄患者血管壁斑块变化情况

Vessel Wall Plaque Changes in Patients with Middle Cerebral Artery Stenosis Using 3.0T High Resolution Magnetic Resonance Imaging

背景动脉粥样硬化引起的颅内动脉狭窄是造成缺血性脑卒中的主要原因,而常规影像学检查仅能显示管腔形态,无法显示管壁结构。高分辨率磁共振成像(HR-MRI)可用于观察动脉粥样硬化斑块形成及发展,辅助判断斑块稳定性,进而评估相关疾病发生风险。目的基于3.0T HR-MRI观察大脑中动脉狭窄患者血管壁斑块变化情况,以为脑卒中的临床诊疗提供参考依据。方法选取中国人民解放军联勤保障部队第910医院2016年收治的大脑中动脉狭窄(狭窄率≥50%)患者40例,其中缺血性脑卒中20例,非缺血性脑卒中20例。随访2年,每6个月复查一次HR-MRI。患者在随访期间均严格按照神经内科医嘱积极治疗。分别比较缺血性脑卒中、非缺血性脑卒中患者出院后6、12、18、24个月管壁标准化指数(NWI)及责任斑块高度,并观察其脑血管事件发生情况。结果缺血性脑卒中患者出院前及出院后6、12、18、24个月NWI、责任斑块高度比较,差异无统计学意义(P>0.05)。非缺血性脑卒中患者出院前及出院后6、12、18、24个月NWI、责任斑块高度比较,差异无统计学意义(P>0.05)。缺血性脑卒中、非缺血性脑卒中患者随访期间均未发生脑血管事件。结论通过HR-MRI发现,大脑中动脉狭窄患者在常规治疗下血管壁斑块稳定,且脑血管事件再发风险较低。

Background Intracranial artery stenosis caused by atherosclerosis is the main cause of ischemic stroke.Conventional imaging techniques reveal only the shape changes of the lumen,but not the wall structure modifications.High resolution magnetic resonance imaging(HR-MRI)can be used to examine the formation and development of the carotid atherosclerotic plaques,assist in judging the plaque stability,and evaluate the risk of related diseases.Objective To examine the vascular wall plaque changes in patients with middle cerebral artery stenosis using 3.0T HR-MRI,which supports the clinical diagnosis and treatment of stroke.Methods Fourty patients with middle cerebral artery stenosis(stenosis rate≥50%)were recruited for the study in the 910th Hospital in 2016,among whom 20 cases with ischemic stroke and the other 20 cases with non-ischemic stroke.All patients were followed up for 2 years,and were examined with HR-MRI every 6 months.During the period patients were treated in strict accordance with the medical advice of the doctors in the Neurology Department.The normalized wall index and responsibility plaque height were recorded for comparison at months 6,12,18,24 after discharge,and the incidence of cerebrovascular events were registered.Results There was no significant difference in the normalized wall index and responsibility plaque height at 6,12,18,24 months after discharge in patients with ischemic stroke and patients with non-ischemic stroke(P>0.05).No cerebrovascular events occurred during the follow-up period in patients with ischemic stroke and patients with non-ischemic stroke.Conclusion HR-MRI shows that the condition of the vascular wall plaque is stable and the risk of cerebrovascular events is low in patients with middle cerebral artery stenosis treated conventionally.