基于高分辨率血管壁MRI的颈部及颅内动脉夹层临床危险因素和影像特征

Clinical Risk Factors and Imaging Features of Cervical and Intracranial Artery Dissection Based on High-Resolution Vessel Wall MRI

目的基于高分辨率血管壁MRI(VW-MRI)分析颈部动脉夹层(CAD)及颅内动脉夹层(IAD)的潜在临床危险因素及影像特征的差异。资料与方法回顾性分析2015年8月—2021年12月在福建医科大学附属第一医院就诊的91例颅颈部动脉夹层患者,其中CAD 58例、IAD 33例,对比分析两组的潜在临床危险因素(性别、年龄、颈部按摩理疗史、吸烟史、饮酒史、高血压、糖尿病及高脂血症等)及VW-MRI特征(缺血性脑卒中发生率、前/后循环分布、单发/多发病灶、范围局限型/广泛型、内膜瓣、双腔征、壁间血肿、血管外管径扩张、MRA管腔形态分型)的差异。结果CAD和IAD组患者年龄[(42.2±11.4)岁比(47.2±8.8)岁,t=2.188]、高血压[11(19.0%)比15(45.5%),χ^(2)=7.232]、甘油三酯水平[1.12(0.81,1.51)mmol/L比1.41(1.06,1.83)mmol/L,Z=-2.729]比较,差异均有统计学意义(P均<0.05)。VW-MRI特征对比分析显示,CAD和IAD在缺血性脑卒中发生率[50(86.2%)比21(63.6%),χ^(2)=6.249]、前/后循环分布[后循环16(28.1%)比32(97.0%),χ^(2)=39.863]、单发/多发病灶、范围局限型/广泛型(χ^(2)=21.638)及MRA管腔形态分型上差异有统计学意义(P均<0.05)。结论基于高分辨率VW-MRI分析显示CAD和IAD的潜在临床危险因素及MR特征存在一定差异,提示两者的潜在发病机制及病变特征可能存在不同。

Purpose To compare the clinical risk factors and imaging features between cervical artery dissection(CAD)and intracranial artery dissection(IAD)based on high-resolution vessel wall magnetic resonance imaging(VW-MRI).Materials and Methods High-resolution VW-MRI features and clinical risk factors of 91 patients from the First Affiliated Hospital of Fujian Medical University from August 2015 to December 2021 were retrospectively analyzed.The differences in clinical risk factors(including sex,age,history of neck massage,smoking status,alcohol intake,hypertension,diabetes,and hyperlipidemia)and VW-MRI features(including the incidence of ischemic stroke,anterior/posterior circulation,single/multiple lesion,focal/extensive range,intimal flap,double lumen sign,intramural hematoma,extravascular dilation,lumen classification on MRA)between 58 patients with CAD and 33 patients with IAD were compared.Results Significant differences were observed in age[(42.2±11.4)years vs.(47.2±8.8)years,t=2.188],the prevalence of hypertension[11(19.0%)vs.15(45.5%),χ^(2)=7.232],triglyceride levels[1.12(0.81,1.51)mmol/L vs.1.41(1.06,1.83)mmol/L,Z=-2.729],the incidence of cerebral infarction[50(86.2%)vs.21(63.6%),χ^(2)=6.249],involvement of anterior/posterior circulation vessels[posterior circulation vessels 16(28.1%)vs.32(97.0%),χ^(2)=39.863],single/multiple lesion,focal/extensive range(χ^(2)=21.638)and lumen classification on MRA(all P<0.05).Conclusion Based on high-resolution VW-MRI analysis,several clinical risk factors and imaging features differed between CAD and IAD,which may indicate distinct underlying mechanisms and characteristics.