磁共振高分辨血管壁成像在诊断缺血性脑卒中患者颅内动脉硬化疾病中的应用

High resolution magnetic resonance angiography in diagnosis of intracranial arteriosclerosis in patients with ischemic stroke

目的探究磁共振高分辨血管壁成像(HR-VWI)在诊断缺血性脑卒中患者颅内动脉硬化疾病中的应用。方法选取2019年1月至2021年2月聊城市第三人民医院收治的80例颅内动脉硬化缺血性脑卒中患者,根据病理情况分为动脉-动脉栓塞组(同一血管支配区存在单发皮层梗死或多发梗死)、穿支动脉受累组(豆纹动脉和脑桥旁支动脉供血区病变)。动脉-动脉栓塞组43例,其中男24例,女19例,年龄57~75岁;穿支动脉受累组37例,其中男22例,女15例,年龄56~76岁。两组患者均行数字减影血管造影(DSA)、HR-VWI检查,统计HR-VWI颅内动脉硬化检出情况,对比两组颅内动脉改变情况、颅内动脉硬化斑块形态相关指标,采用SPSS 23.0分析数据,计量资料比较采用t检验,计数资料采用χ^(2)检验,一致性采用Kappa指数检验,P<0.05为差异有统计学意义。结果HR-VWI、DSA检查颅内动脉硬化狭窄程度准确度分别为93.75%(75/80)、100.00%(80/80),差异无统计学意义(P>0.05)。HR-VWI检查颅内动脉硬化诊断狭窄程度Kappa指数(0.911)较高(P<0.05)。经HR-VWI检查,动脉-动脉栓塞组血管壁厚度为(0.42±0.08)mm、管腔内径为(2.28±0.64)mm、管腔面积为(4.51±1.28)mm^(2),穿支动脉受累组分别为(0.40±0.16)mm、(2.25±0.61)mm、(4.45±1.12)mm^(2),两组比较,差异均无统计学意义(均P>0.05)。两组斑块位置、重构形式、重构指数、强化率对比,差异均有统计学意义(t=51.098、23.978、2.295、17.890,均P<0.05)。结论HR-VWI在缺血性脑卒中患者颅内动脉硬化疾病中的诊断价值较高,可有效诊断颅内动脉管壁结构及斑块形态相关信息,对临床诊治及病情评估具有积极意义。

Objective To explore the application of magnetic resonance high-resolution vascular wall imaging(HR-VWI)in the diagnosis of intracranial arteriosclerosis in patients with ischemic stroke.Methods Eighty patients with intracranial arteriosclerosis ischemic stroke treated in Liaocheng Third People's Hospital from January 2019 to February 2021 were divided into an artery-artery embolization group(single cortical infarction or multiple infarction in the same vascular innervation area)and a perforator artery involvement group(lesions in the blood supply area of lenticular artery and parapontine artery).There were 43 cases in the artery-artery embolization group,including 24 males and 19 females,and they were 57-75 years old.There were 37 cases in the perforator artery involvement group,including 22 males and 15 females,and they were 56-76 years old.All the patients were examined by digital subtraction angiography(DSA)and HR-VWI.The detection of intracranial arteriosclerosis by HR-VWI was counted.The changes of intracranial arteries and the related indicators of intracranial arteriosclerosis plaque morphology were compared between the two groups.SPSS 23.0 was used to analyze the data.The measurement data were compared between these two groups by t test,and the enumeration data byχ^(2) test.The coincidence was tested by the Kappa index.If P<0.05,there was a statistical difference.Results There was no statistical difference in the accuracy of intracranial arteriosclerosis stenosis between HR-VWI and DSA[93.75%(75/80)vs.100.00%(80/80),P>0.05].The Kappa index(0.911)of intracranial arteriosclerosis diagnosed by HR-VWI was higher(P<0.05).The vessel wall thickness,lumen diameter,and lumen area by HR-VWI were(0.42±0.08)mm,(2.28±0.64)mm,and(4.51±1.28)mm^(2) in the artery-artery embolization group,and were(0.40±0.16)mm,(2.25±0.61)mm,and(4.45±1.12)mm^(2) in the perforator artery involvement group,with no statistical differences between the two groups(all P>0.05).There were statistical differences in the plaque location,remodeling form,remodeling index,and enhancement rate between the two groups(t=51.098,23.978,2.295,and 17.890;all P<0.05).Conclusions HR-VWI has high value in the diagnosis of intracranial arteriosclerosis in patients with ischemic stroke.It can effectively diagnose intracranial artery wall structure and get the relevant information of plaque morphology,and has positive significance for clinical diagnosis,treatment,and condition evaluation.