磁共振高分辨力血管壁成像在缺血性脑卒中的研究进展

Research progress of high resolution magnetic resonance angiography in ischemic stroke

颅内外动脉粥样硬化是缺血性脑卒中的主要病因,其中斑块易损性和斑块位置与缺血性脑卒中的病因判断及治疗方式的选择息息相关。目前,磁共振高分辨力血管壁成像依赖于多种可以同时抑制脑脊液及血液信号的黑血技术,实现了对颅内外动脉粥样硬化斑块的精细显示,成为脑血管病高危人群脑卒中筛查的有效手段。血管壁成像不仅可以观察管腔,也可观察血管壁内斑块的成分,并对斑块进行全面地分析,准确量化斑块内的各种成分,观察斑块与穿支血管入口的关系,为缺血性脑卒中患者的病因分型、药物疗效评价及手术方式的选择提供了充分的影像依据。本文就高分辨力血管壁成像技术及其对斑块特征的评估价值、卒中病因分型和临床治疗疗效评价方面进行综述,并着重提出了他汀类药物的最佳使用剂量及时长可作为今后的研究方向。

Intracranial and extracranial atherosclerosis is the main cause of ischemic stroke,in which plaque vulnerability and plaque location are closely related to the cause of ischemic stroke and the choice of treatment.At present,magnetic resonance high resolution vascular wall imaging relies on a variety of black blood technologies that can inhibit cerebrospinal fluid and blood signals at the same time,realizing the fine display of intracranial and extracranial atherosclerotic plaque,and becoming an effective means of stroke screening for high-risk population of cerebrovascular disease.In addition to observing the lumen,vascular wall imaging can also observe the components of plaque in the vascular wall,and conduct a comprehensive analysis of the plaque,which can accurately quantify the various components in the plaque,observe the relationship between the plaque and the entrance of the perforator,and provide sufficient imaging basis for the etiology classification,drug efficacy evaluation,and selection of surgical methods of ischemic stroke patients.This article reviews the high resolution vascular wall imaging technology and its evaluation value for plaque characteristics,the etiology classification of stroke and the evaluation of clinical therapeutic efficacy,it is emphasized that the best dosage and duration of statins can be taken as the future research direction.