3.0T高分辨磁共振在缺血性脑血管病基底动脉狭窄中的应用

目的3.0T HR-MRI 评估缺血性脑卒中患者基底动脉粥样硬化性狭窄的血管壁特征和重塑模式。方法回顾分析2017年1月至2019年10月基底动脉粥样硬化患者50例,NIHSS评分评估卒中严重程度在症状组和无症状组之间,根据血管面积比较包括T2WI,T2WI和PDWI的HR-MRI基底动脉狭窄壁的橫截面图像,测量狭窄部位和参照部位的管腔面积,壁面积,斑块面积,狭窄程度和重塑指数结果23例症状组N丨HSS评分显著大于27例无症状组(P<0.001)。腔内最窄处,症状组血管壁面积(P=0.018)与斑块面积(P<0.001)均大于无症状组,管腔面积小于无症状组(P<0.03)。血管狭窄程度症状组明显大于无症状组(P<0.001)。症状患者中正性重塑组的比例也显著大于无症状组(73.9%和29.6%,P=0.001)。结论高分辨MRI为检测颅内动脉壁特征和揭示重塑模式与缺血性卒中最有效工具,正性重塑是不安全的重塑方式,容易引起急性缺血性卒中。

Objective To evaluate the vascular wall characteristics and remodeling pattern of basilar artery(BA)stenosis in patients with ischemic stroke using 3.0T HR-MRI.Methods 50 patients with basilar artery stenosis received from January 2017 to October 2019 were retrospectively analyzed,and NIHSS score was calculated for each patient to evaluate the stroke severity.Cross-sectional images of BA stenosis on HR-MRI including T1WI,T2WI and PDWI series were used to compare the wall area between symptomatic group and asymptomatic group,and the lumen area,plaque area,stenosis degree and remodeling index of both groups were measured respectively.Data were analyzed with SPSS software.Results The NIHSS score of symptomatic group(n=23)was significantly higher than that of asymptomatic group(n=27)(13.3±5.3 vs 5.4±2.5,P<0.001).In the narrowest segment,the wall area(P=0.018)and plaque area(P<0.001)in the symptomatic group were significantly larger than those in the asymptomatic group,while the lumen area was relatively smaller when compare with the asymptomatic group(P<0.03).And the degree of stenosis in the symptomatic group was much higher than that in the asymptomatic group(63.4±13.2 vs 48.2±10.3,P<0.001).In addition,the proportion of parients with positive remodeling was remarkably increased in the symptomatic groups(73.9%vs 29.6%,P=0.001).Conclusions HR-MRI has become the most promising tool for assessing the characteristics of intracranial artery waU and reveal the relationship between remodeling pattern and ischemic stroke.Posirive remodeling is a high-risk remodeling pattern that highly associated with acute ischemic stroke.