3.0T高分辨率磁共振成像對(duì)腦橋旁正中梗死的診斷價(jià)值

盧曄芬，邱偉文，曾婷婷，程偉進(jìn)，陳建軍，饒杰

（1.麗水市中心醫(yī)院 神經(jīng)內(nèi)科，浙江 麗水 323000；2.麗水市人民醫(yī)院 神經(jīng)內(nèi)科，浙江 麗水323000）

3.0T高分辨率磁共振成像對(duì)腦橋旁正中梗死的診斷價(jià)值

盧曄芬1，邱偉文2，曾婷婷1，程偉進(jìn)1，陳建軍1，饒杰1

（1.麗水市中心醫(yī)院 神經(jīng)內(nèi)科，浙江 麗水 323000；2.麗水市人民醫(yī)院 神經(jīng)內(nèi)科，浙江 麗水323000）

目的：應(yīng)用3.0T高分辨磁共振成像（HRMRI）對(duì)基底動(dòng)脈粥樣硬化斑塊進(jìn)行分析在腦橋旁正中梗死（PPI）中的診斷價(jià)值。方法：連續(xù)入組孤立PPI患者53例，行頭顱磁共振血管成像（MRA）和HRMRI檢查，比較兩者基底動(dòng)脈狹窄檢出率。應(yīng)用HRMRI分析基底動(dòng)脈粥樣硬化斑塊的分布、成分特點(diǎn)及重構(gòu)指數(shù)（RI）等。結(jié)果：MRA上發(fā)現(xiàn)19例有基底動(dòng)脈狹窄（占35.84%），HRMRI發(fā)現(xiàn)34例患者有基底動(dòng)脈狹窄（占64.15%），2者差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。HRMRI發(fā)現(xiàn)44例患者有基底動(dòng)脈粥樣硬化斑塊（占83.01%），斑塊位于前壁、左壁居多，偏心斑塊占90.91%，不穩(wěn)定斑塊占59.09%。陰性重構(gòu)15例，無(wú)重構(gòu)12例，陽(yáng)性重構(gòu)17例。13例可見斑塊位于PPI責(zé)任血管的穿支動(dòng)脈口。結(jié)論：HRMRI對(duì)基底動(dòng)脈狹窄的檢出率高，PPI患者基底動(dòng)脈斑塊大多分布前壁和左壁，斑塊不穩(wěn)定性高。HRMRI對(duì)基底動(dòng)脈斑塊分析在PPI中具有較高診斷價(jià)值。

高分辨磁共振成像；腦橋旁正中梗死；動(dòng)脈粥樣硬化；基底動(dòng)脈；重構(gòu)指數(shù)

Abstract: Objective:To apply 3.0T high-resolution MRI (HRMRI) in the diagnosis of basilar atherosclerotic in paramedian pontine infarction (PPI).Methods:Consecutive 53 patients with PPI were performed MRA and HRMRI, compared the differences in assessing the basal artery stenosis between the two methods. The distribution, composition features and remodeling index of basilar artery atherosclerosis were observed using HRMRI,the correlation of basilar artery atherosclerosis and cerebral infarction were analyzed.Results:Nineteen cases of basal artery stenosis deteeted by MRA (35.84%) compared with 34 cases detected by HRMRI (64.15%), there were significant statistically differences (P＜0.05). Forty-four cases of basilar artery atherosclerosis were detected by HRMRI (83.01%). The basilar artery atherosclerosis were mainly distributed in the front and left sites, the percentage of eccentric plaques was 90.91% and unstable plaque was 59.09%. Negative remodeling was found in 15 patients, intermediate remodeling in 12 patients, and positive remodeling in 17 patients. The basilar artery plaques at or near the origin of the penetrating artery in 13 cases.Conclusion:HRMRI is more sensitive to detect basilar artery stenosis compared with MRA. The basilar artery atherosclerosis mainly distributes in the front and left sites in PPI patients, and plaque instability is high incidence. Morphological analysis of basal artery plaque using HRMRI has high value in patiens of PPI.

Key words:high-resolution MRI; paramedian pontine infarction; atherosclerosis; basilar artery; remodeling index

腦橋旁正中梗死（paramedian pontine infarction，PPI）是指腦橋旁正中部位發(fā)生的梗死，大多因腦橋旁正中動(dòng)脈（基底動(dòng)脈穿支）發(fā)生閉塞所致。常規(guī)血管影像檢查方法，如磁共振血管成像（magnetic resonance angiography，MRA）、CT血管成像（CT angiography，CTA）只能顯示管腔的內(nèi)部情況，無(wú)法顯示管壁結(jié)構(gòu)；當(dāng)動(dòng)脈粥樣硬化未引起明顯血管狹窄時(shí)，可能遺漏病變。……