3.0T磁共振血管壁成像在椎-基底动脉粥样硬化血管壁与后循环脑梗死的关系研究

3.0T magnetic resonance vessel wall imaging in relationship between vertebrobasilar atherosclerotic vessel wall and posterior circulation cerebral infarction

目的采用3.0T磁共振血管壁成像(3.0T magnetic resonance imaging,3.0T MRI)评估椎-基底动脉粥样硬化血管壁与后循环脑梗死(posterior circulation cerebral infarction,PCCI)的关系。方法前瞻性选取2020年3月至2022年1月聊城市第三人民医院收治的117例PCCI患者,均行3.0T MRI检查,查出椎-基底动脉粥样硬化血管壁改变,存在动脉粥样硬化斑块。记录观察责任斑块分布、厚度及强化情况,计算责任血管的重构指数(remodeling index,RI),以此分为正性重构组(RI≥1.05,82例)、负性重构组(RI≤0.95,27例),0.95<RI<1.05为无重构(8例)。正性重构组男50例,女32例,年龄51~72(61.08±4.84)岁;负性重构组男16例,女11例,年龄52~74(62.46±5.02)岁;测量PCCI责任血管管壁,比较两组血管壁特点、RI、斑块负荷,采用t、χ^(2)检验。结果椎-基底动脉粥样硬化斑块背侧壁分布最多(38.46%,45/117),其次为左侧壁(23.08%,27/117),环形最少(5.13%,6/117);斑块厚度以>0.5~1.5 mm为主(70.09%,82/117),0~0.5 mm最少(13.68%,16/117)。两组斑块形态、斑块信号对比,差异均无统计学意义(χ^(2)=0.112、1.201,均P>0.05)。正性重构组斑块明显强化占比(70.73%,58/82)高于负性重构组(37.04%,10/27),两组比较,差异有统计学意义(χ^(2)=11.723,P=0.008);责任血管管腔最窄层面分析显示,正性重构组血管、斑块、管壁及管腔面积均大于负性重构组(均P<0.05);正性重构组血管RI、斑块负荷均高于负性重构组(t=12.521、6.541,均P<0.05)。结论3.0T MRI应用于PCCI可显示椎-基底动脉粥样硬化血管壁改变,进行病因诊断,对临床治疗方案的制定具有指导意义。

Objective To evaluate the relationship between vertebrobasilar atherosclerotic vessel wall and posterior circulation cerebral infarction(PCCI)using 3.0T magnetic resonance vessel wall imaging(3.0T MRI).Methods One hundred and seventeen patients with PCCI admitted to Liaocheng Third People's Hospital from March 2020 to January 2022 were selected.All of them were examined by 3.0T MRI for atherosclerotic vessel wall changes in vertebrobasilar arteries and the presence of atherosclerotic plaques.The distribution,thickness,and intensification of the responsible plaques were recorded and observed;the remodeling index(RI)of the responsible vessel was calculated.According to the RI,the patients were divided into a positive remodeling group(RI≥1.05;82 cases),a negative remodeling group(RI≤0.95;27 cases),and a no remodeling(0.95<RI<1.05;8 cases).There were 50 males and 32 females in the positive remodeling group who were 51-72(61.08±4.84)years old.There were 16 males and 11 females in the positive remodeling group who were 52-74(62.46±5.02)years old.The vessel wall of the responsible vessel of PCCI was measured;the vessel wall characteristics,RI's,and plaque loads of the two groups were compared.t andχ^(2) tests were applied.Results The distribution of vertebrobasilar atherosclerotic plaques was the mos t in the dor sal wal l(38.46%,45/117),fol lowed by the lef t wal l(23.08%,27/117),and the least in the circumferential shape(5.13%,6/117);plaque thickness was predominant ly>0.5-1.5 mm(70.09%,82/117)and the leas t between 0 and 0.5 mm(13.68%,16/117).The differences in plaque morphology and plaque signal between the two groups were not statistically significant(χ^(2)=0.112 and 1.201;both P>0.05).The percentage of significant plaque enhancement was higher in the positive remodeling group(70.73%,58/82)than in the negative remodeling group(37.04%,10/27),with a statistical difference(χ^(2)=11.723,P=0.008).The analysis of the narrowest level of the responsible vessel lumen showed that the vessel,plaque,vessel wall,and lumen area in the positive remodeling group were larger than those in the negative remodeling group(all P<0.05).The vessel RI and plaque load in the positive remodeling group were higher than those in the negative remodeling group(t=12.521 and 6.541;both P<0.05).Conclusion 3.0T MRI applied to PCCI can show the alteration of vertebrobasilar artery atherosclerotic vessel wall,make etiological diagnosis,and guide the development of clinical treatment plan.