【作者】 李娜；

【导师】 方乐；

【作者基本信息】 吉林大学 ， 神经病学（专业学位）， 2021， 硕士

【摘要】 目的:采用3.0T高分辨率磁共振成像(HR-MRI)技术,对MRA大脑中动脉M1-M2段局部血流信号消失,远端显影良好的患者进行成像,探讨此处血管壁的影像学特征及其可能代表的临床意义。方法:选取我院2018年1月至2020年12月于我院进行HR-MRI检查的患者,入组患者为MRA大脑中动脉M1-M2段局部明显中断,HR-MRI未显示闭塞,根据MCA狭窄程度分为轻度狭窄、中度狭窄、重度狭窄组,观察MCA M1-M2段的影像学特点,探讨其可能代表的临床意义,并按照指南给与二级预防,进行长期随访,观察入组患者缺血性脑卒中的终点事件,探讨缺血性脑卒中复发的危险因素。结果:1、本研究共入组符合纳入标准患者82例,轻度狭窄24例,中度狭窄33例,重度狭窄24例,1例血管变异。其中重度狭窄中有一例微小血管流空信号影。三组间中度狭窄的患者中男性患者占比(78.8%)较轻度狭窄(41.7%)、重度狭窄(62.5%)的患者高,且三组间的差异有统计学意义(P<0.05),三组间年龄、高血压病病史、糖尿病病史、高血脂病病史、高同型半胱氨酸病病史、吸烟、急性脑卒中的差异无统计学意义(P>0.05)。2、MCA轻度狭窄的患者中,上壁斑块9例(11.1%),下壁斑块9例(11.1%),腹侧壁斑块3例(3.6%),背侧壁斑块3例(3.6%)。中度狭窄的患者中,上壁斑块8例(10.1%),下壁斑块13例(16.0%),腹侧壁斑块9例(11.1%),背侧壁斑块3例(3.6%),重度狭窄的患者中,上壁斑块6例(7.4%),下壁斑块8例(10.1%),腹侧壁斑块9例(11.1%),背侧壁斑块1例(1.2%),MCA M1-M2段斑块更倾向分布在下壁,三组之间的差别无统计学意义。((?)2=5.328,P>0.05)。3、轻度狭窄的患者中,不稳定斑块16例(19.8%),稳定斑块8例(10.1%),中度狭窄的患者中,不稳定斑块11例(13.6%),稳定斑块22例(27.2%),重度狭窄的患者中,不稳定斑块2例(2.4%),稳定斑块22例(27.2%),三组间差异有统计学意义。(P<0.0001)4、以缺血性脑卒中为终点事件,行Cox比例风险回归分析,年龄、高血压病病史、糖尿病病史、高血脂病病史、高同型半胱氨酸病病史、吸烟之间的差异无统计学意义。结论:1、粥样硬化斑块所致大脑中动脉狭窄是其在MRA中出现局部血液流动信号消失的主要原因。2、目前,没有确切的依据支持MRA大脑中动脉局部血流信号的中断与缺血性脑卒中的复发之间存在显著的相关性。更多还原

【Abstract】 Objective:Use 3.0T high resolution magnetic resonance imaging(HR-MRI)technology to image the patients whose middle cerebral artery M1-M2 segment local blood flow signal is lost in MRA and distal imaging is well,which explores the imaging characteristics of the blood vessel wall and Its possible clinical significance.Method:Selected patients who underwent HR-MRI examinations in our hospital from January 2018 to December 2020 in our hospital.The included Patients were MRA middle cerebral artery M1-M2 segments with significant local interruption,HR-MRI showed no occlusion,according to the degree of MCA stenosis Divided into mild stenosis,moderate stenosis,severe stenosis group,observe the imaging characteristics of MCA M1-M2 segment,and explore its Possible clinical significance.Follow the guidelines to give secondary Prevention,carry out long-term follow-up,observe whether the end-Point event of the enrolled Patients occurs,and explore the risk factors for recurrence of ischemic stroke.Result:1.The study enrolled 82 patients who met the inclusion criteria,including 24 cases mild stenosis,33 cases moderate stenosis,24 cases severe stenosis,and 1 vascular variation.Among them,there is a case of small blood vessel empty signal shadow in severe stenosis.Among the three groups,the proportion of male patients with moderate stenosis(78.8%)was higher than that of Patients with mild stenosis(41.7%)and severe stenosis(62.5%),and the difference between the three groups was3 statistically significant(P<0.05)),there was no significant difference in age,history of hypertension,history of diabetes,history of hyperlipidemia,history of hyperhomocysteinemia,smoking,and acute stroke among the three group Ps(P>0.05).2.Among patients with mild MCA stenosis,9 cases(11.1%)were upper wall plaques,9 cases(11.1%)were inferior wall plaques,3 cases(3.6%)were ventral wall plaques,and 3 cases(3.6%)were dorsal wall plaques.Among the patients with moderate stenosis,8 cases(10.1%)had upper wall plaques,13 cases(16.0%)had inferior wall plaques,9cases(11.1%)had ventral wall plaques,and 3 cases(3.6%)had dorsal wall plaques.Among patients with severe stenosis,6 cases(7.4%)of upper wall plaques,8 cases(10.1%)of inferior wall plaques,9 cases(11.1%)of ventral wall plaques,and 1 case(1.2%)of dorsal wall plaques,MCA M1-M2 plaques tended to be distributed in the inferior wall,and the difference between the three groups was not statistically significant.(2=0.502,P>0.05).3.Among patients with mild stenosis,16 cases(19.8%)were unstable plaques,8 cases(10.1%)were stable plaques,and among patients with moderate stenosis,11 cases(13.6%)were unstable plaques and stable plaques There were 22 cases(27.2%)with severe stenosis,2cases(2.4%)with unstable plaques and 22 cases(27.2%)with stable plaques.The difference between the three groups was statistically significant.(P<0.0001)4.With ischemic stroke as the endpoint,Cox proportional hazard regression analysis,there is no statistical difference between age,history of hypertension,history of diabetes,history of hyperlipidemia,history of hyperhomocysteinemia,and smoking Learn meaning.Conclusion:1.Middle cerebral artery stenosis caused by atherosclerotic plaque is the main reason for the disappearance of local blood flow signal in MRA.2.At present,there is no definite basis to support the significant correlation between the interruption of the local blood flow signal of the MRA middle cerebral artery and the recurrence of ischemic stroke.更多还原