大脑中动脉斑块的影像特征及临床应用价值

Imaging features of plaque at middle cerebral artery and clinical diagnostic value

目的:探讨大脑中动脉(MCA)粥样硬化斑块的影像特征及与急性或亚急性脑梗死的相关性。方法:回顾性分析2019年1月~2020年10月安徽省立医院南区94例脑卒中或短暂性脑缺血发作患者的影像资料(107处斑块),按相应MCA供血区有无急性或亚急性脑梗死(依照DWI和FLIAR序列显示),分成症状组(60处)与非症状组(47处),分析斑块特征。结果:症状组的重构指数(RI)及强化信号比(1.10±0.30和1.33±0.62)高于非症状组(0.95±0.16和1.00±0.57),P<0.05。症状组主要分布于上侧及背侧(36.67%和33.33%),而非症状组主要分布于下侧及腹侧(36.17%和31.91%),P<0.05;症状组正性重构(46.67%)为主,而非症状组负性重构(55.32%)为主(P<0.05)。结论:上侧及背侧强化程度较高的斑块及正性重构的血管,未来发生卒中风险较高,需积极采取临床干预及治疗。

Objective:To investigate the imaging features of atherosclerotic plaque at middle cerebral artery(MCA)and the association of the imaging with acute or subacute cerebral infarction.Methods:Imaging data were collected from 94 patients with stroke or transient ischemic attack(a total of 107 plaques at the MCA)undergone high resolution magnetic resonance vessel wall imaging(HRMR VWI)in Anhui Provincial Hospital between January 2019 and October 2020,and retrospectively analyzed.The plaques were classified as symptomatic group(n=60)and asymptomatic group(n=47)based on presence or absence of acute or subacute infarction at the blood supply area at scanning by T2 FLAIR and DWI to examine the plaque features.Results:Symptomatic group had higher remodeling index(1.10±0.30)and enhancement ratio(1.33±0.62)than those of asymptomatic group(P<0.05).The plaques most occurred at superior and dorsal wall in patients in symptomatic group(36.67%;33.33%),while were more seen at inferior and ventral wall in those in asymptomatic group(36.17%;31.91%)(P<0.05).Symptomatic group exhibited higher proportion of positive remodeling(46.67%),and asymptomatic group were dominated by negative remodeling(55.23%)(P<0.05).Conclusion:Superior/dorsal plaques or higher enhancement ratio plaque as well as positive arterial remodeling are greater risks for stroke,which suggests that patients with such imaging signs require earlier clinical intervention and positive treatment.