急性孤立性脑桥梗死与椎基底动脉系统血管角度斑块位置分布的相关性

Study on the correlation between acute isolated pontine infarction and vascular angle and plaque location distribution of vertebrobasilar system

目的 应用三维时间飞跃法磁共振成像(3D TOF MRA)及高分辨磁共振成像(HRMRI)通过分析不同类型急性孤立性脑桥梗死(AIPI)与血管角度、基底动脉(BA)上斑块位置分布的相关性,为不同类型AIPI发病机制的探讨提供理论依据,更好地指导临床治疗。方法 收集2020-10—2022-12在青海大学附属医院神经内科收治的经扩散加权成像(DWI)检查证实为AIPI的患者作为研究对象。依据病灶在DWI上的位置及形态特征,将AIPI患者分为旁正中型脑桥梗死(PPI)组、深部脑桥腔隙性梗死(DPLI)组、脑桥外侧梗死(LPI)组。使用半自动测量软件RadiAnt DICOM Viewer 2.3(64-bit)在重建血管3D TOF MRA图像上进行手动测量BA中间角度(mid-BA)以及椎动脉(vertebral artery,VA)与BA之间的角度(VABA);在HRMRI的3D-SPACE T1WI序列轴位图像上,评估斑块位置分布(腹侧壁、背侧壁、左侧壁、右侧壁),收集各组的临床基本资料及影像学数据,并进行统计分析。结果 (1)PPI、DPLI、LPI 3组在VABA、mid-BA的总体分布上差异存在统计学意义(P<0.05),其中PPI组VA-BA的中位数(32.0)大于DPLI组的中位数(16.85);LPI组mid-BA的中位数(36.59)大于PPI组中位数(19.10),差异均有统计学意义(P<0.05)。(2)PPI、DPLI、LPI 3组BA上斑块位置分布差异存在统计学意义(χ^(2)=23.319,P<0.001),其中,相较于PPI组及LPI组,DPLI组大多无BA斑块(14.6%对6.7%对58.3%);相较于DPLI组及LPI组,BA背侧壁斑块更多见于PPI组(12.5%对40.0%对48.8%);相较于PPI组及DPLI组,BA左右侧壁斑块更多见于LPI组(31.7%对16.7%对46.7%)。(3)根据BA上斑块位置的分布,将80例AIPI患者分成4组:无斑块组、腹侧壁组、背侧壁组和左右侧壁组。其中,无斑块组21例(26.25%)、腹侧壁组6例(7.5%)、背侧壁组29例(36.25%)、左右侧壁组24例(30%)。将4组的VA-BA角度、mid-BA角度进行比较,4组在VA-BA角度、mid-BA角度的总体分布上差异均有统计学意义(P<0.05),其中背侧壁组的VA-BA角度大于无斑块组,差异有统计学意义(P<0.05);左右侧壁组的mid-BA角度大于无斑块组,差异有统计学意义(P<0.05)。结论 PPI组VA-BA角度更大,斑块位置更常分布在BA背侧壁;DPLI组BA上大多无斑块;LPI组mid-BA角度更大,斑块位置更常分布在BA两侧壁。

Objective To analyze the correlation between different types of acute isolated pontine infarction(AIPI)and vascular angle,plaque location distribution on basilar artery(BA)by three dimensions time of flight magnetic resonance angiography(3D TOF MRA)and high resolution magnetic resonance imaging(HRMRI).It provides a theoretical basis for the discussion of the pathogenesis of different types of AIPI and better guides clinical treatment.Methods Patients with AIPI confirmed by diffusion weighted imaging(DWI)in the Department of Neurology of our hospital from October 2020 to December 2022 were collected as subjects.According to the location and morphological characteristics of the lesion on DWI,AIPI patients were divided into paramedian pontine infarction(PPI)group,deep pontine lacunar infarction(DPLI)group and lateral pontine infarction(LPI)group.The middle angle of BA(mid-BA)and the angle between vertebral artery(VA)and BA(VA-BA)were manually measured on the reconstructed 3D TOF MRA image using semi-automatic measurement software RadiAnt DICOM Viewer 2.3(64-bit).On the 3D-SPACE T1WI sequence axial image of HRMRI,the distribution of plaque location(ventral wall,dorsal wall,left wall,right wall)was evaluated,and the basic clinical data and imaging data of each group were collected and analyzed.Results There were statistical differences in the overall distribution of VA-BA and mid-BA among PPI,DPLI and LPI groups(P<0.05).The median of VA-BA in PPI group(32.0)was greater than that in DPLI group(16.85).The median of mid-BA in LPI group(36.59)was higher than that in PPI group(19.10),and the difference was statistically significant(P<0.05).There were statistically significant differences in the distribution of plaques on BA among PPI,DPLI and LPI groups(χ^(2)=23.319,P<0.001).Among them,compared with PPI group and LPI group,DPLI group mostly had no BA plaques(14.6% vs6.7% vs 58.3%);compared with DPLI group and LPI group,BA dorsal wall plaques were more common in PPI group(12.5% vs 40.0% vs 48.8%).Compared with PPI group and DPLI group,the left and right side wall plaques of BA were more common in LPI group(31.7% vs 16.7% vs 46.7%).According to the distribution of plaque location on BA,80 AIPI patients were divided into 4 groups:no plaque group,ventral wall group,dorsal wall group and left and right wall group.Among them,there were 21 cases(26.25%)in the non-plaque group,6cases(7.5%)in the ventral wall group,29 cases(36.25%)in the dorsal wall group,and 24 cases(30%)in the left and right wall group.The VA-BA angle and mid-BA angle of the four groups were compared.The results showed that there were statistical differences in the overall distribution of VA-BA angle and mid-BA angle among the four groups(P<0.05).The VA-BA angle of the dorsal wall group was greater than that of the non-plaque group,and the difference was statistically significant(P<0.05).The mid-BA angle of the left and right side wall group was larger than that of the non-plaque group,and the difference was statistically significant(P<0.05).Conclusion The VA-BA angle of PPI group is larger,and the plaque location is more often distributed in the dorsal wall of BA.Most of BA in DPLI group had no plaque;the mid-BA angle of the LPI group was larger,and the plaque location was more often distributed on both sides of the BA wall.