摘要
目的探讨烟雾综合征(moyamoya syndrome,MMS)大血管狭窄特征与脑梗死模式的关系。材料与方法回顾性分析自2016年10月至2020年4月在济宁医学院附属医院确诊的101例MMS患者的临床及影像资料。所有患者均行MRI平扫及磁共振血管成像(magnetic resonance angiography,MRA)检查,根据患者是否存在脑梗死分为梗死组及无梗死组,脑梗死模式分为穿支动脉梗死、皮质动脉梗死、分水岭梗死及多发性梗死;以单侧大脑半球为单位进行评估,根据Houkin’s MRA评分标准对颈内动脉(internal carotid artery,ICA)、大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、大脑后动脉(posterior cerebral artery,PCA)狭窄程度进行评价,采用卡方检验评价组间大血管受累率以及脑梗死模式与大血管狭窄程度的相关性,采用Spearman相关分析评价MRA评分与脑梗死模式的关系。结果101例MMS患者中梗死组42例(48侧半球),无梗死组59例(102侧半球)。梗死模式分别为皮质动脉梗死(29.2%)、穿支动脉梗死(16.7%)、分水岭梗死(16.7%)及多发性梗死(37.5%)。梗死侧与无梗死侧MMS的大脑半球相比,ACA、MCA及ICA受累比例差异无统计学意义(P均>0.05),梗死侧PCA受累比例明显高于无梗死侧(64.6%vs.30.4%,P<0.05)。皮质动脉梗死及多发性梗死在PCA重度狭窄或闭塞组中所占比例(40%、50%)明显高于正常组及轻中度狭窄组(P均<0.05)。相关分析显示MRA评分与多发性梗死之间呈正相关(r=0.648,P<0.05)。结论PCA受累导致MMS患者脑梗死的发生率较高,推测是引起脑梗死的相关因素,当PCA重度狭窄或闭塞时,梗死模式以皮质动脉梗死和多发性梗死最为常见。此外,MRA评分与多发性梗死模式存在一定相关性。
Objective: To explore the relationship between the features of large vessel stenosis and the patterns of cerebral infarction in moyamoya syndrome(MMS). Materials and Methods: The clinical and imaging data of 101 MMS patients diagnosed in the Affiliated Hospital of Jining Medical University from October 2016 to April 2020 were retrospectively analyzed. All patients underwent MRI and magnetic resonance angiography(MRA), and were divided into infarction group and non-infarction group according to whether the patients had cerebral infarction. The cerebral infarction patterns were divided into perforating artery infarct, pial artery infarct,border-zone infarct and multiple infarcts;The evaluation is performed in units of one cerebral hemisphere, the degree of stenosis of the internal carotid artery(ICA), anterior cerebral artery(ACA), middle cerebral artery(MCA), and posterior cerebral artery(PCA) was evaluated according to Houkin’s MRA scores, Chi-square test was used to evaluate the prevalence of large vessel involvement and the correlation between the patterns of cerebral infarction and the degree of large vessel stenosis in different groups, and Spearman correlation analysis was used to investigated the relationships between MRA scores and cerebral infarction patterns. Results: Among the101 MMS patients, 42 were in the infarction group(48 hemispheres), and 59 were in the non-infarction group(102 hemispheres), the infarct patterns were pial artery infarct(29.2%), perforating artery infarct(16.7%), border-zone infarct(16.7%), and multiple infarcts(37.5%). There were no significant difference in the prevalence of ACA, MCA and ICA involvement in the cerebral hemisphere of MMS between the infarct side and the non-infarct side(all P>0.05), the prevalence of PCA involvement on the infarct side was significantly higher than that on the non-infarct side(64.6% vs. 30.4%, P<0.05). The proportions of pial artery infarct and multiple infarcts in PCA severe stenosis or occlusion group(40%, 50%) were significantly higher than that in normal group and mild to moderate stenosis group(all P<0.05). Correlation analysis showed that there was a positive correlation between MRA scores and multiple infarcts(r=0.648, P<0.05). Conclusions: PCA involvement leads to a higher incidence of cerebral infarction in MMS patients, which is presumed to be a related factor causing cerebral infarction. Pial artery infarct and multiple infarcts are the most common infarct patterns in severe stenosis or occlusion of PCA, and there is a certain correlation between MRA scores and multiple infarcts.
作者
刘尚宽
郭翔
于昊
陈雨各
陈月芹
LIU Shangkuan;GUO Xiang;YU Hao;CHEN Yuge;CHEN Yueqin(Clinical School,Jining Medical University,Jining 272013,China;Department of Medical Imaging,Affiliated Hospital of Jining Medical University,Jining 272029,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2022年第8期80-83,91,共5页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金(编号:82001805)
山东省自然科学基金(编号:ZR2021MH109)。
关键词
烟雾综合征
狭窄
磁共振成像
磁共振血管成像
脑梗死
moyamoya syndrome
stenosis
magnetic resonance imaging
magnetic resonance angiography
cerebral infarction
