摘要
目的探讨磁共振高信号血管征(HVS)的临床意义和影响因素。方法分析2017年4月—2019年8月解放军北部战区总医院收治的109例急性前循环闭塞性脑梗死患者的临床资料及相关影像参数,所有患者发病24 h内完成头部液体衰减反转恢复(FLAIR)序列、弥散加权成像(DWI)及三维时间飞跃法磁共振血管成像(3D TOF MRA)检查。根据FLAIR序列将HVS的分布范围分为4级(0、1、2、3级),进一步将患者分为HVS低级组(0和1级)与高级组(2和3级),采用单因素和多因素回归分析影响HVS分布的相关因素。选取发病6 h内先于磁共振成像完成基线CT扫描的52例患者,行Alberta卒中项目早期CT评分(ASPECTS)半定量评估脑梗死体积,计算CT-ASPECTS与DWI-ASPECTS的差值,以ASPECTS的差值≤1分为ASPECTS未变化(AN)组,ASPECTS的差值>1分为ASPECTS变化(AY)组,比较HVS的级别在两组间是否存在差异,并将HVS分级与ASPECTS的差值进行Spearman相关分析。结果高脂血症、TOAST分型[大动脉粥样硬化型(LAA)/心源性栓塞型(CE)/其他或病因不明型(SOE或SUE)]、Willis环分型(Ⅰ/Ⅱ/Ⅲ/Ⅳ型)在HVS低级组与高级组间比较差异有统计学意义[分别为58.6%(34/58)比37.3%(19/51),χ²=4.959,P=0.026;23/5/23比43/1/14,P=0.004;3/14/12/22比7/29/14/8,χ²=13.124,P=0.004]。其他临床因素与血管闭塞位置均差异无统计学意义(P>0.05)。多因素回归分析结果显示,TOAST分型中LAA型(LAA型比SOE或SUE型,OR=3.054,95%CI 1.257~7.422,P=0.014)及Willis环Ⅰ型(Willis环Ⅰ型比Ⅳ型,OR=5.494,95%CI 1.074~28.091,P=0.041)、Ⅱ型(Willis环Ⅱ型比Ⅳ型,OR=5.571,95%CI 1.895~16.372,P=0.002)是促进HVS广泛分布的独立影响因素。HVS的分级(低级/高级)在AN与AY组间比较差异有统计学意义(1/15比18/18,χ²=9.114,P=0.002)。Spearman相关分析结果显示HVS分级与ASPECTS的差值呈负相关(r=-0.573,P<0.001)。结论TOSAT分型、Willis环分型是影响HVS分布的重要因素。HVS分级反映侧支代偿�
Objective To investigate clinical significance and related factors of magnetic resonance hyperintense vessel sign(HVS).Methods The clinical data and related imaging parameters of 109 patients with acute anterior circulation occlusion cerebral infarction,who admitted to Northern Theater Command General Hospital of People′s Liberation Army from April 2017 to August 2019,were analyzed retrospectively.Brain magnetic resonance imaging(MRI)examinations including fluid attenuated inversion recovery(FLAIR),diffusion weighted imaging(DWI)and three dimensional time of flight magnetic resonance angiography(3D TOF MRA)sequences within 24 hours of onset were performed.According to the distribution range of HVS in FLAIR sequence,the patients were divided into four grades(0,1,2 and 3),grades 0 and 1 belonging to HVS low grade group,and grades 2 and 3 HVS high grade group.Univariate and multivariate analyses were made to explore related factors of HVS.Fifty-two patients who completed baseline CT within six hours of onset before MRI examination were performed CT-Alberta Stroke Program Early CT Score(CT-ASPECTS)and DWI-Alberta Stroke Program Early CT Score(DWI-ASPECTS).The difference between CT-ASPECTS and DWI-ASPECTS was calculated.When the difference of ASPECTS≤1,they were categorized as ASPECTS unchanged group(AN group);when the difference of ASPECTS>1,they were categorized as ASPECTS changed group(AY group).These two groups were compared to explore whether there was any difference in HVS grade,and Spearman correlation analysis was performed to investigate the relationship between HVS grade and the difference of ASPECTS.Results The difference of hyperlipidemia,TOAST classification(large artery atherosclerosis(LAA),other etiology(SOE)or undetermined etiology(SUE))and Willis circle classification(typesⅠ,Ⅱ,ⅢandⅣ)between HVS groups were remarkable(58.6%(34/58)vs 37.3%(19/51),χ²=4.959,P=0.026;23/5/23 vs 43/1/14,P=0.004;3/14/12/22 vs 7/29/14/8,χ²=13.124,P=0.004).Other clinical factors and the locations of vessel occlu
作者
宋鸿雁
段阳
杨本强
徐志华
张楠
裴禹淞
张晓君
杨发军
李晓秋
Song Hongyan;Duan Yang;Yang Benqiang;Xu Zhihua;Zhang Nan;Pei Yusong;Zhang Xiaojun;Yang Fajun;Li Xiaoqiu(Postgraduate Training Base of Jinzhou Medical University,Northern Theater Command General Hospital of People′s Liberation Army,Shenyang 110016,China;Department of Radiology,Northern Theater Command General Hospital of People′s Liberation Army,Shenyang 110016,China;Department of Radiology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Huzhu County People′s Hospital,Huzhu,Qinghai 810599,China;Department of Neurosurgery,Northern Theater Command General Hospital of People′s Liberation Army,Shenyang 110016,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2020年第11期924-931,共8页
Chinese Journal of Neurology
基金
辽宁省自然科学基金资助项目(201602768)。
关键词
磁共振成像
高信号血管征
WILLIS环
脑梗塞
Magnetic resonance imaging
Hyperintense vessel sign
Willis circle
Brain infarction
