Abstract:

Objective　To analyze the characteristics and value of high-resolution magnetic resonance imaging (HR-VWI) in patients with ischemic stroke. Methods　A prospective study was conducted on 60 ischemic stroke patients admitted to Liaocheng Third People's Hospital from October 2020 to December 2021, including 34 males and 26 females who were 25-75 (53.27±6.22) years old. The Chinese ischemic stroke subclassification (CISS) was used to classify the patients according to their symptoms, medical history, laboratory tests, and routine imaging examinations. CISS classification was performed again after HR-VWI examination. The CISS classification before and after HR-VWI examination was compared; the imaging characteristics were analyzed. According to the relationship between plaque and responsible artery in their ischemic areas, the patients were divided into a responsible plaque group (20 cases) and a non-responsible plaque group (16 cases). The measurement data and the count data were processed by t and χ² tests, respectively. The HR-VWI characteristics of the two groups were analyzed. Results　The CISS classification results showed that there were 20 cases (33.33%) of large arterial atherosclerosis (LAA), 6 cases (10.00%) of cardioembolic stroke (CS), 17 cases (28.33%) of perforating artery lesions, 1 case (1.67%) of other etiological type (OE), and 16 cases (26.67%) of undetermined etiology (UE). Thirty-six (60.00%) of the 60 patients had the same type, and 24 (40.00%) had different types before and after HR-VWI examination. After HR-VWI examination, the proportion of LAA type increased by 35.00%, the proportion of perforating artery lesion type decreased by 23.33%, and the proportion of UE type decreased by 13.33%. There was a statistical difference in CISS classification rate between before and after HR-VWI examination (χ²=17.833, P<0.05). HR-VWI of intracranial blood vessels showed that of the 60 patients, 30.00% (18 cases with 25 vessels) had no obvious abnormality on intracranial blood vessel walls; 10.00% (6 cases with 11 vessels) had wall thickening; 60.00% (36 cases with 96 vessels) had atherosclerotic plaques on intracranial blood vessel walls. The proportions of the patients with lumen stenosis ≥ 50%, plaque located in middle cerebral artery, and significantly enhanced plaque in the responsible plaque group [40.00%(8/20), 55.00%(11/20), and 50.00%(10/20)] were higher than those in the non-responsible plaque group [6.25%(1/16), 25.00%(4/16), and 6.25%(1/16)], with statistical differences (χ²=5.400, 8.730, and 8.048; all P<0.05). The wall area of the responsible plaque group was larger than that of the non-responsible plaque group [(14.33±2.87) mm² vs. (11.76±1.14) mm²]; the lumen area of the responsible plaque group was smaller than that of the non-responsible plaque group [(2.96±0.40) mm² vs. (5.44±1.29) mm²]; the stenosis rate of the responsible plaque group was higher than that of the non-responsible plaque group [(70.44±3.96)% vs. (39.15±2.04)%]; there were statistical differences (t=3.368, 8.147, and 28.654; all P<0.05). The percentage of lumen stenosis was lower than 50%; most of the plaques located in middle cerebral artery and basilar artery; the plaques were significantly enhanced; the wall area was large; the lumen area was small; the stenosis rate was higher in the responsible plaque group. Conclusion　HR-VWI can help to identify intracranial arterial lesions in patients with ischemic stroke, and evaluate the state of arteriosclerosis, thereby providing a basis for clinical treatment and prognosis evaluation.

Key words:

Ischemic stroke, High-resolution magnetic resonance imaging, Vessel wall imaging,  , Diagnostic value

摘要：

目的　分析缺血性卒中患者高分辨磁共振血管壁成像（HR-VWI）特点及价值。方法　选取2020年10月至2021年12月聊城市第三人民医院收治的60例缺血性卒中患者为研究对象进行前瞻性研究，其中男34例，女26例，年龄25～75（53.27±6.22）岁。根据患者症状、病史、实验室检查及常规影像学检查进行初步中国缺血性卒中亚型（CISS）分型，且经HR-VWI检查后再次行CISS分型，对比HR-VWI检查前后CISS分型，分析血管壁成像特点，并根据患者斑块与缺血区责任动脉的关系分为责任斑块组（20例）与非责任斑块组（16例）。计量资料采用t检验，计数资料行χ²检验，分析两组的HR-VWI特征。结果　初步CISS分型为：大动脉粥样硬化型（LAA）20例（33.33%），心源性卒中型（CS）6例（10.00%），穿支动脉病变型（PAD）17例（28.33%），其他病因型（OE）1例（1.67%），病因不确定型（UE）16例（26.67%）。60例患者HR-VWI检查后60.00%（36/60）分型一致，40.00%（24/60）分型不一致。HR-VWI检查后大动脉粥样硬化型所占的比例升高了35.00%，穿支动脉病变型所占的比例下降23.33%，不明原因型所占的比例降低了13.33%，HR-VWI检查前后CISS分型率比较，差异有统计学意义（χ²=17.833，P<0.05）。60例患者经HR-VWI检查颅内血管，30.00％（18例，25支）患者颅内血管壁未见明显异常，10.00％（6例，11支）患者发现管壁增厚，60.00％（36例，96支）患者颅内血管上发现粥样硬化斑块存在。责任斑块组管腔狭窄≥50％、斑块位置位于大脑中动脉、斑块明显强化者比例为40.00％（8/20）、55.00％（11/20）、50.00％（10/20），均高于非责任斑块组［6.25％（1/16）、25.00％（4/16）、6.25％（1/16）］，差异均有统计学意义（χ²=5.400、8.730、8.048，均P<0.05）；责任斑块组管壁面积为（14.33±2.87）mm²，高于非责任斑块组的（11.76±1.14）mm²；管腔面积为（2.96±0.40）mm²，低于非责任斑块组的（5.44±1.29）mm²；狭窄率为（70.44±3.96）％，高于非责任斑块组的（39.15±2.04）％，差异均有统计学意义（t=3.368、8.147、28.654，均P<0.05），责任斑块组管腔狭窄以<50％位置，斑块位置多见大脑中动脉与基底动脉，斑块强化成明显强化，管壁面积较大，管腔面积较小，狭窄率较高。结论　HR-VWI可识别缺血性卒中患者颅内动脉病变，评估动脉硬化血管状态，为指导临床治疗决策及预后判断提供一定依据。

关键词:

缺血性卒中, 高分辨磁共振, 血管壁成像, 诊断价值