中国卒中杂志2016，Vol.11Issue(8)：619-625,7.DOI:10.3969/j.issn.1673-5765.2016.08.003
大脑中动脉粥样硬化的狭窄度与卒中机制--一项高分辨磁共振研究
Stroke Mechanisms of Middle Cerebral Artery Plaque in Different Stenosis Rate：a High Resolution Magnetic Resonance Imaging Study
摘要
Abstract
Objective To explore the mechanism of stroke in different middle cerebral artery (MCA) stenosis rate, by understanding the association of MCA stenosis rate, MCA plaque morphology and infarct pattern in stroke patients. <br> Methods Patients with ischemic stroke in MCA territory within 2 weeks in Peking Union Medical College Hospital from 2009 to 2014 were consecutively collected. Patients with MCA plaque on high-resolution magnetic resonance imaging (HRMRI) were included, and patients with cardio-embolic, extracranial large artery atherosclerotic stroke and other causes of stroke were excluded from the study. The infarct lesions were classiifed into penetrating artery, cortical, watershed (or border zone) and mixed infarction, and then the infarct volume on diffusion weighted image (DWI) was calculated. On sagittal HRMRI, the stenosis rate of MCA M1 segment, plaque distribution, length, thickness, signal and surface discontinuity were assessed. Patients with stenosis rate >50%were severe stenosis group, and patients with stenosis rate ≤50% were mild stenosis group. <br> Results One hundred and two patients were analyzed, of whom, 39 patients were in severe stenosis group and 63 in mild stenosis group. Severe stenosis group had 14 cases of penetrating artery infarction (35.9%), 9 cortical infarction (23.1%), 4 watershed infarction (10.3%) and 12 mixed infarction (30.8%); mild stenosis group had 44 penetrating artery infarction (69.8%), 8 cortical infarction (12.7%), 3 watershed infarction (5.8%) and 8 mixed infarction (12.7%). The proportion of two groups had signiifcant difference (P=0.014). The severe stenosis group had longer (P<0.001) and thicker (P<0.001) plaques, and more mixed-signal plaques (P<0.001). The plaque thickness (P<0.001,OR 87.792, 95%CI 13.120-587.453) and mixed-signal of plaque (P=0.007,OR 7.358, 95%CI 1.725-31.382) were independent predicting factors of MCA stenosis >50%. In severe stenosis group, the infarct volume was related to plaque surface discontinuity (P=0.004).In mild stenosis group, the infarct pattern was related to plaque surface discontinuity (P=0.002) and plaque thickness (P=0.002). The plaque discontinuity was the independent predicting factor of embolic infarction (P=0.003,OR 5.778, 95%CI 1.788-18.672) in mild stenosis group. <br> Conclusion Patients with MCA stenosis >50% or ≤50% have different proportion of infarct pattern and plaque morphological markers. The surface discontinuity of plaques with stenosis ≤50% is the independent risk factor of embolic infarction, indicating the potential stroke mechanism of mild stenotic MCA.关键词
粥样硬化斑块/高分辨磁共振/脑卒中机制/大脑中动脉/颅内动脉狭窄Key words
Atherosclerotic plaque/High resolution magnetic resonance imaging/Stroke mechanism/Middle cerebral artery/Intracranial arterial stenosis引用本文复制引用
虞雁南,许玉园,李明利,高山,冯逢,徐蔚海..大脑中动脉粥样硬化的狭窄度与卒中机制--一项高分辨磁共振研究[J].中国卒中杂志,2016,11(8):619-625,7.基金项目
教育部新世纪优秀青年基金（NCET-12-0069）北京协和医学院青年基金和中央高校青年基金国家自然科学基金（81471207）首都卫生发展科研专项基金 （）
