Abstract:

Objective　To explore the characteristics of intracranial arterial wall plaques on plain CT angiography (CTA) and high-resolution magnetic resonance imaging (HR-MRI) in patients with posterior circulation ischemia. Methods　One hundred patients with posterior circulation ischemia treated at Liaocheng Third People's Hospital from March 2019 to May 2023 were selected, including 49 patients with transient ischemic attack (TIA) and 51 patients with cerebral infarction. There were 58 males and 42 females; they were (57.76 ± 8.92) years old. The CTA judgment of cerebral vascular stenosis and collateral circulation and the detection of plaques by CTA and HR-MRI were analyzed. The differences in HR-MRI plaque parameters between the with patients TIA and cerebral infarction were analyzed. The consistency analysis was conducted using Kappa test. The differences between groups were analyzed using t test or χ² test. Results　The Kappa value of the results of CTA judging cerebral vascular stenosis compared to digital subtraction angiography (DSA) was 0.761 (P<0.05); the accuracy of CTA in judging cerebral vascular stenosis was 85.00% (85/100). The Kappa value of CTA in determining cerebral vascular collateral circulation compared to DSA was 0.820 (P<0.05); the accuracy of CTA in determining cerebral vascular collateral circulation was 91.00% (91/100). The detection rates of plaques in the patients with cerebral infarction by CTA and HR-MRI were 92.16% (47/51) and 90.20% (46/51), respectively, which were higher than those in the patients with TIA [77.55% (38/49) and 73.47% (36/49)] (χ²=4.181 and 4.737; both P<0.05). Comparison of HR-MRI plaque parameters: the plaque area of cerebral infarction, plaque load, and remodeling index in the patients with cerebral infarction were higher than those in the patients with TIA [(5.86±0.92) mm² vs. (3.94±0.82) mm²,(26.17±4.82)% vs. (21.14±4.43)%, and (1.19±0.19) vs. (1.10±0.20)], with statistical differences (t=-11.001, -5.427, and -2.308; all P<0.05). The proportions of positive remodeling, vulnerable plaques, and plaques located on the ventral or upper wall in the patients with cerebral infarction were higher than those in the patients with TIA [82.35% (42/51) vs. 63.27% (31/49), 72.55% (37/51) vs. 34.69% (17/49), and 76.47% (39/51) vs. 36.73% (18/49)], with statistical differences (χ²=4.619, 14.417, and 16.099; all P<0.05). Conclusions　CTA has certain value in judging cerebral vascular stenosis and collateral circulation in patients with posterior circulation ischemia. At the same time, there are significant differences in HR-MRI plaque parameters between patients with TIA and cerebral infarction of posterior circulation ischemia.

Key words:

CT vascular imaging, High resolution nuclear magnetic resonance imaging, Posterior circulation ischemia, Plaques

摘要：

目的　探讨后循环缺血患者头颅CT血管成像（CTA）及高分辨率磁共振成像（HR-MRI）颅内动脉管壁斑块特征。方法　选取2019年3月至2023年5月在聊城市第三人民医院就诊的后循环缺血患者100例，年龄（57.76±8.92）岁，男58例，女42例。其中，短暂性脑缺血发作（TIA）患者49例，脑梗死患者51例。分析CTA判断脑血管狭窄、侧支循环情况及CTA、HR-MRI斑块检出情况，分析TIA和脑梗死患者HR-MRI斑块参数差异，一致性分析采用Kappa检验，组间差异采用t检验、χ²检验。结果　CTA判断脑血管狭窄的结果与数字减影血管造影（DSA）检查结果Kappa值为0.761，P<0.05，CTA判断脑血管狭窄的准确率为85.00%（85/100）；CTA判断脑血管侧支循环的结果与DSA检查结果Kappa值为0.820，P<0.05，CTA判断脑血管侧支循环的准确率为91.00%（91/100）；脑梗死患者CTA、HR-MRI斑块检出率分别为92.16%（47/51）和90.20%（46/51），明显高于TIA患者［77.55%（38/49）、73.47%（36/49）］，差异均有统计学意义（χ²=4.181、4.737，均P<0.05）；HR-MRI斑块参数比较：脑梗死患者斑块面积、斑块负荷、重构指数分别为（5.86±0.92）mm²，（26.17±4.82）%、（1.19±0.19），明显高于TIA患者［（3.94±0.82）mm²，（21.14±4.43）%、（1.10±0.20）］，差异均有统计学意义（t=-11.001、-5.427、-2.308，均P<0.05）；脑梗死患者正性重构比例、易损斑块比例、斑块位于腹侧或上侧壁比例分别为82.35%（42/51）、72.55%（37/51）、76.47%（39/51），明显高于TIA患者［63.27%（31/49）、34.69%（17/49）、36.73%（18/49）］，差异均有统计学意义（χ²=4.619、14.417、16.099，均P<0.05）。结论　CTA在后循环缺血患者脑血管狭窄及侧支循环判断中有一定应用价值，TIA和脑梗死患者HR-MRI斑块参数有明显差异。

关键词:

CT血管成像, 高分辨率核磁共振成像, 后循环缺血, 斑块