大脑中动脉粥样硬化性脑梗死患者高分辨率MRI表现及其诊断价值研究

High Resolution MRI Findings in Patients with Middle Cerebral Artery Atherosclerosis Cerebral Infarction and Their Diagnostic Value

目的探讨高分辨率MRI成像(HRMRI)对大脑中动脉粥样硬化性脑梗死的诊断价值。方法选取70例行高分辨率MRI检查的患者,根据患者病种分为大脑中动脉(MCA)粥样硬化性脑梗死43例和短暂性脑缺血发作(TIA)27例。诊断患者的脑梗死类型、粥样硬化斑块、MCA血管情况。结果43例MCA粥样硬化性脑梗死患者中,多发性脑梗死15例(34.88%),单发性脑梗死28例(65.12%);分水岭脑梗死21例(48.84%),流域性脑梗死10例(23.26%),半卵圆区脑梗死7例(16.28%),腔隙性脑梗死5例(11.63%)。脑梗死患者管腔狭窄、多发狭窄、粥样硬化斑块、不稳定斑块的比例均高于TIA患者(P<0.05)。脑梗死患者的MCA管壁厚度大于TIA患者,管腔内径、管腔面积均小于TIA患者(P<0.05)。脑梗死患者侧支循环良好26例(60.47%),不良17例(39.53%);TIA患者侧支循环良好21例(77.78%),不良6例(22.22%),差异无统计学意义(P>0.05)。结论高分辨率MRI能清晰显示MCA管壁结构,观察管腔狭窄和粥样硬化斑块,对于MCA粥样硬化性脑梗死具有重要诊断意义。

Objective To investigate the diagnostic value of high resolution magnetic resonance imaging(HRMRI)in middle cerebral artery atherosclerosis cerebral infarction.Methods 70 patients undergoing HRMRI were enrolled.According to the disease types,they were divided into 43 cases with middle cerebral artery(MCA)atherosclerosis cerebral infarction and 27 cases with transient ischemia attach(TIA).The cerebral infarction types,atherosclerotic plaque,MCA vascular condition were diagnosed.Results Of the 43 patients with MCA atherosclerosis cerebral infarction,there were 15(34.88%)cases with multiple cerebral infarction,28(65.12%)cases with single cerebral infarction,21(48.84%)cases with cerebral watershed infarction,10(23.26%)cases with basin cerebral infarction,7(16.28%)cases with cerebral infarction in semi-oval area,and 5(11.63%)cases with lacunar infarction.The proportion of luminal stenosis,multiple stenosis,atherosclerotic plaque,and unstable plaque in patients with cerebral infarction was higher than that in TIA patients(P<0.05).The thickness of MCA wall in patients with cerebral infarction was larger than that in TIA patients,while the lumen diameter and lumen area were smaller than those in TIA patients(P<0.05).Among the cerebral infarction patients,there were 26 cases(60.47%)with good collateral circulation,17 cases(39.53%)with poor collateral circulation.Among the TIA patients,there were 21 cases(77.78%)with good collateral circulation,6 cases(22.22%)with poor collateral circulation(P>0.05).Conclusion High resolution MRI can clearly show the structure of MCA wall,observe luminal stenosis and atherosclerotic plaque,which is of important diagnostic value for MCA atherosclerosis cerebral infarction.