Hr-MRI对急性脑梗死患者颅内动脉评估及其二级预防中的应用价值

The Value of HR-MRI in the Evaluation of Intracranial Arteries in Patients with Acute Cerebral Infarction in its Secondary Prevention

目的:探讨高分辨率磁共振成像(HR-MRI)对急性脑梗死(ACI)患者颅内动脉评估及其二级预防中的应用价值。方法:回顾性分析本院2019年1月—12月收诊的150例ACI患者病历资料,均进行HRMRI检查,比对病理及随访结果,初步明确ACI发生病因。纳入ACI颅内动脉粥样硬化患者作进一步分析,按责任斑块及前后循环进行分组,比较管腔狭窄程度、斑块强化程度、管壁重构以及斑块负荷。结果:病理及随访结果显示,150例ACI中阳性组84例、阴性组66例。阳性组年龄、高血压均高于阴性组(P<0.05);比对病理及随访结果,经HR-MRI病因预测灵敏度为94.05%、特异度为75.76%、准确率为86.00%,Kappa值为0.711;纳入ACI阳性组84例,经HR-MRI共检出斑块214个。责任斑块组管壁增厚模式Ⅱ型、斑块表面不规则、斑块负荷高于非责任斑块组(P<0.05),经秩和检验,两组管腔狭窄程度及斑块强化程度有统计学差异(P<0.05);前循环组斑块负荷高于后循环组(P<0.05)。结论:HR-MRI有助于ACI病因预测,且通过颅内动脉粥样硬化所致ACI管腔狭窄、管壁增厚、重构特征以及斑块强化、负荷等形态综合评估,利于疾病鉴别诊断,从而为二级预防提供重要指导。

Objective:To explore the application value of high-resolution magnetic resonance imaging(HR-MRI)in the evaluation and secondary prevention of intracranial arteries in patients with acute cerebral infarction(ACI).Methods:The medical records of 150 ACI patients admitted in our hospital from January 2019 to December 2019 were retrospectively analyzed.HR-MRI examinations were performed.The pathological and follow-up results were compared,and the cause of ACI was preliminarily determined.Included ACI patients with intracranial atherosclerosis for further analysis,grouped by responsible plaque and anterior and posterior circulation,and compared the degree of lumen stenosis,plaque enhancement,wall remodeling and plaque load.Results:The results of pathology and follow-up showed that among 150 cases of ACI,84 cases were in the positive group and 66 cases were in the negative group.The age and hypertension of the positive group were higher than those of the negative group(P<0.05);compared with the pathological and follow-up results,the sensitivity of HRMRI etiological prediction was 94.05%,specificity was 75.76%,accuracy rate was 86.00%,and Kappa value 0.711;84 cases were included in the ACI positive group,and a total of 214 plaques were detected by HR-MRI.The thickness of the tube wall in the responsible plaque group is typeⅡ,the surface of the plaque is irregular,and the plaque load is higher than that in the non-responsible plate group(P<0.05).After the rank sum test,the degree of lumen stenosis and plaque enhancement of the two groups are There was a statistical difference(P<0.05);the plaque burden in the anterior circulation group was higher than that in the posterior circulation group(P<0.05).Conclusion:HR-MRI is helpful to predict the cause of ACI,and comprehensive evaluation of ACI lumen stenosis,wall thickening,reconstruction characteristics,plaque enhancement,load and other morphological features caused by intracranial atherosclerosis is beneficial to the differential diagnosis of the disease,So as to provide important guidance for secondary prevention.