大脑中动脉粥样硬化斑块特征及脑灌注分析与急性脑梗死发生的相关性研究The correlation between the characteristics of middle cerebral artery atherosclerotic plaque,cerebral perfusion and the occurrence of acute cerebral infarction
闫天志;张超;刘清祥;黄琦;黄显军;周运锋;
摘要(Abstract):
目的 通过应用高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI及CT灌注(computed tomography perfusion,CTP)成像对症状性大脑中动脉(middle cerebral artery,MCA)粥样硬化狭窄患者的斑块特征及血流灌注进行分析,探寻与急性脑梗死(acute cerebral infarction,ACI)相关的高危影像特征。材料与方法 回顾性分析64例发病时间小于4周的症状性MCA粥样硬化狭窄患者的HRMR-VWI及CTP影像资料。根据扩散加权成像(diffusion weight imaging,DWI)和临床表现,将患者分为ACI组和短暂性脑缺血发作(transient ischemic attack,TIA)组,分析两组斑块特征、灌注参数及侧支评分的差异,构建多变量Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线、计算曲线下面积(area under the curve,AUC),评估显著变量及其联合模型对ACI预测价值。结果 共纳入64例患者。TIA组共25例,女10例,年龄(55.12±11.20)岁。ACI组共39例,女11例,年龄(57.90±9.62)岁。两组间性别(P=0.327)、年龄(P=0.296)差异无统计学意义。与TIA组相比,ACI组的斑块长度更长[6.10 (3.20,12.3) mm vs. 4.10(2.15,5.55) mm, P=0.006]、负荷更大[86.83%(80.26%,100.00%) vs. 78.46%(72.70%,87.66%), P=0.007]、狭窄程度[86.76%(76.19%,100.00%) vs. 75.72%(60.94%,85.84%), P=0.008]、强化程度(P<0.001)及强化指数[(1.19±0.55) vs.(0.58±0.46),P<0.001]均更高,同时其相对平均通过时间(relative mean transit time, rMTT)[(1.19±0.22) vs.(1.05±0.17), P=0.007]、相对流出时间(relative time to drain,rTTD)[(1.52±0.47) vs.(1.19±0.30),P=0.003]、相对剩余函数达峰时间(relative time to the center of the impulse response function,rTmax)[(2.26±1.33) vs.(1.55±0.67),P=0.007]均更大。多因素Logistic回归分析显示:斑块长度(OR=1.17,95%CI:1.001~1.362,P=0.049)、强化程度(OR=5.18,95%CI:1.848~14.522,P=0.002)及rTmax(OR=2.32,95%CI:1.019~5.298,P=0.045)为ACI的独立预测因子。斑块长度、强化程度及rTmax三者联合模型的预测效能最佳(AUC=0.862,95%CI:0.767~0.956)。结论 HRMR-VWI联合CTP检查能够对症状性MCA粥样硬化斑块特征及下游灌注状态进行全面评估,有助于识别与ACI相关的高危MCA粥样硬化狭窄患者。
关键词(KeyWords): 高分辨率血管壁成像;CT灌注成像;大脑中动脉粥样硬化;短暂性脑缺血发作;急性脑梗死;磁共振成像
基金项目(Foundation): 皖南医学院弋矶山医院科研能力“高峰”骨干项目(编号:GF2019G13)~~
作者(Authors): 闫天志;张超;刘清祥;黄琦;黄显军;周运锋;
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