1、金燦高分辨率磁共振血管壁成像在顱內(nèi)動(dòng)脈粥樣硬化斑塊中的初步應(yīng)用研究1高分辨率磁共振血管壁成像在顱內(nèi)動(dòng)脈粥樣硬化斑塊中的初步應(yīng)用研究摘要第一部分HRMRI上癥狀性大腦中動(dòng)脈粥樣硬化斑塊的分布及形態(tài)學(xué)特征目的采用高分辨率磁共振(highresolutionmagneticresonanceimaging，HRMRI)血管壁成像技術(shù)觀察癥狀性大腦中動(dòng)脈(middlecerebralarteryMCA)粥樣硬化斑塊的分布和形態(tài)學(xué)特征，血清超敏C

2、反應(yīng)蛋白(hsCRP)濃度的變化，初步探討與急性腦梗死相關(guān)的高危斑塊的HRMRI特征。方法對(duì)納入研究的57名大腦中動(dòng)脈粥樣硬化患者進(jìn)行彌散加權(quán)成像(diffusionweightedimaging，DWI)、頭顱MR血管成像(MRangiography，MRA)及大腦中動(dòng)脈HRMRI檢查。根據(jù)DWI檢查結(jié)果將患者分為短暫性腦缺血發(fā)作(transientischemicattack，TIA)組和急性腦梗死組，統(tǒng)計(jì)大腦中動(dòng)脈管腔最狹窄層面斑

3、塊在4個(gè)900扇形區(qū)域的分布情況，定量測(cè)量血管最狹窄處(maximallumennarrowing，MEN)管腔面積(1umenarea，LA皿N)、血管面積(vesselarea，VAMLN)和參考血管的LA化fe，。瞅及Ⅵkfe姍∞，再以此計(jì)算出管壁面積(wallarea，WA)、斑塊面積(plaquearea，PA)、斑塊負(fù)荷百分比、狹窄率、重構(gòu)指數(shù)(remodelingindex，RI)，將各組數(shù)據(jù)進(jìn)行對(duì)比。鼽田當(dāng)日夕R對(duì)57例

4、MCA粥樣硬化斑塊定位分析發(fā)現(xiàn)，癥狀性大腦中動(dòng)脈粥樣硬化斑塊多位于腹側(cè)壁(共19例，333％)，上側(cè)壁(共15例，263％)其次，TIA組與急性腦梗死組各側(cè)壁分布上無明顯差異(P005)。兩組之間VA，。fer蛐。。、LA，。fe一。、VAMLN無明顯差異(胗O05)。急性腦梗死組的VAMLN、WAMLN、PA、狹窄率、斑塊負(fù)荷百分較TIA組大，斑塊表面不光整較TIA組多，而LA池N較TIA組小。HsCRP濃度兩組之間無明顯差異(黔00

5、5)，且均在正常值范圍內(nèi)。重構(gòu)方式以正性重構(gòu)為著，共44例(772％)，兩組之間重構(gòu)方式無明顯差異，均以正性重構(gòu)多見。用受試者工作特征曲線(receiveroperatingcharacteristiccurve，ROC曲線)對(duì)上述檢測(cè)指標(biāo)進(jìn)行分析，發(fā)現(xiàn)斑塊負(fù)荷百分比、狹窄率、P金燦高分辨率磁共振血管壁成像在顱內(nèi)動(dòng)脈粥樣硬化斑塊中的初步應(yīng)用研究3之一，可指導(dǎo)缺血性腦卒中的二級(jí)預(yù)防。關(guān)鍵詞：磁共振成像；卒中；斑塊；動(dòng)脈粥樣硬化Abstra

6、ctPartIMiddlecerebraldistributionandmoarteryatheroscleroticplaqueshologicalcharacteristicsinsymptomaticpatientsbyhighresolutionMagneticResonanceImaging一一PurposeToinvestigatemiddlecerebralartery(MCA)atheroscleroticplaques

7、distributioncharacteristicsandmorphologicalcharacteristicsinsymptomaticpatientsbyhighresolutionMRI，trytoexplorethehighriskfeaturesofMCAplaqueinacutestrokeMethodsWecollected57patientswithmiddlecerebralarteryinfarction，inw

8、hichthirtypatientswithactueischemicstrokesandtwenty—sevenoneswithtransientischemicattacksTheMRIprogramincludeddiffusionweightedimaging(DWI)MRangiography(MRA)，andMCAhighresolutionMRIexaminationsThedistributionofthenarrowe

9、stlumenplaquewasevaluatedbycrosssectiondivisionintofourequalarcs(superior，inferior，ventral，dorsalarcs)Forquantitativeanalysis，wemeasuredmaximallumennarrowing(MLN)，lumenarea(LAMLN)，vesselarea(VAuLN)andLAreference，VArefere

10、nce，thencalculatedwallarea(WA)，plaquearea(PA)，remodelingratio(RI)，plaqueburden，lumenstenosisEachparameterwascomparedbyanalysisResultsOverall，plaquesweremorefrequentlylocatedattheventral(333呦andsuperior(263％)，Theplaquesha

11、venodistributiondiscrepancybetweentwogroups(P)005)Thereare27irregularityofplaquesurfacewereobserved，theconcentrationsofHsCRPareintherangeofnormalvalues，andthereisnosignificantdifferencebetweentwogroups(P)005)Morepositive

12、remodelingwereobservedthannegativeremodelingTheVAMLN，WAMLN，PA，lumenstenosisandplaqueburdeninactueischemicstrokegrouparebiggerthanTIAgroupandmoreirregularityofplaquesurfacewereobserved，whileLAMLNissamllerWeusedreceiverope