中华脑血管病杂志（电子版）
中華腦血管病雜誌（電子版）
중화뇌혈관병잡지（전자판）
CHINESE JOURNAL OF CEREBROVASCULAR DISEASES(ELECTRONIC VERSION)
2012年
2期
7-11
,共5页
李伟力%滕继军%江志娟%齐玉祥
李偉力%滕繼軍%江誌娟%齊玉祥
리위력%등계군%강지연%제옥상
大脑中动脉%脑梗死%磁共振成象%动脉狭窄
大腦中動脈%腦梗死%磁共振成象%動脈狹窄
대뇌중동맥%뇌경사%자공진성상%동맥협착
Middle cerebral artery%Cerebral infarction%Magnetic resonance imaging%Artery stenosis
目的 探讨大脑中动脉(MCA)区脑梗死磁共振扩散加权成像(DWI)成像病灶分布特点及与其供血动脉狭窄程度的关系.方法 回顾性的分析经颅脑磁共振成像(MRI)的DWI序列诊断的急性脑梗死,选择病灶位于MCA分布区,且完善其供血动脉检查,包括头颈部CTA,或颅脑MRA加颈部血管超声的患者108例,排除心源性栓塞、特殊血管病变导致的脑梗死.将梗死按照部位分为腔隙型梗死(SSSI)、皮层下梗死(SI)和混合型梗死(MI),供血动脉分为正常、轻度(50％)、重度(50％)和闭塞.比较不同类型梗死组的供血动脉狭窄的发生率.结果 各种梗死类型的发生率之间差异无统计学意义(x2=1.08,P＞0.05).单纯MCA病变者53例(53/108,49.1％),单纯ICA病变者28例(28/108,25.9％),单纯MCA病变高于单纯ICA病变(x2=12.35,P＜0.01).同侧血管正常者以LI类型的梗死多见,而单纯ICA病变者以MI类型的梗死多见(x2=10.22;10.54,P＜0.01)；三种梗死类型在单纯MCA病变患者中差异无统计学意义(x2=0.25,P＞0.05)；在单纯MCA病变者中,SI梗死类型多见于MCA闭塞患者(x2=7.45,P＜0.05).LI梗死类型多见于MCA轻度或重度狭窄患者(x2=6.39,P＜0.05).结论 结合DWI和相应血管检查对于明确MCA区动脉粥样硬化性脑梗死的病因和机制有一定帮助.基底节区的腔隙梗死,相应血管检查正常提示小血管病的可能大；MCA存在一定狭窄则可能是穿支受累造成；ICA病变多累及皮层,包括皮层型分水岭区梗死；而不同程度的MCA病变其梗死形态没有本质区别,皮层下梗死更多见MCA闭塞患者.
目的 探討大腦中動脈(MCA)區腦梗死磁共振擴散加權成像(DWI)成像病竈分佈特點及與其供血動脈狹窄程度的關繫.方法 迴顧性的分析經顱腦磁共振成像(MRI)的DWI序列診斷的急性腦梗死,選擇病竈位于MCA分佈區,且完善其供血動脈檢查,包括頭頸部CTA,或顱腦MRA加頸部血管超聲的患者108例,排除心源性栓塞、特殊血管病變導緻的腦梗死.將梗死按照部位分為腔隙型梗死(SSSI)、皮層下梗死(SI)和混閤型梗死(MI),供血動脈分為正常、輕度(50％)、重度(50％)和閉塞.比較不同類型梗死組的供血動脈狹窄的髮生率.結果 各種梗死類型的髮生率之間差異無統計學意義(x2=1.08,P＞0.05).單純MCA病變者53例(53/108,49.1％),單純ICA病變者28例(28/108,25.9％),單純MCA病變高于單純ICA病變(x2=12.35,P＜0.01).同側血管正常者以LI類型的梗死多見,而單純ICA病變者以MI類型的梗死多見(x2=10.22;10.54,P＜0.01)；三種梗死類型在單純MCA病變患者中差異無統計學意義(x2=0.25,P＞0.05)；在單純MCA病變者中,SI梗死類型多見于MCA閉塞患者(x2=7.45,P＜0.05).LI梗死類型多見于MCA輕度或重度狹窄患者(x2=6.39,P＜0.05).結論 結閤DWI和相應血管檢查對于明確MCA區動脈粥樣硬化性腦梗死的病因和機製有一定幫助.基底節區的腔隙梗死,相應血管檢查正常提示小血管病的可能大；MCA存在一定狹窄則可能是穿支受纍造成；ICA病變多纍及皮層,包括皮層型分水嶺區梗死；而不同程度的MCA病變其梗死形態沒有本質區彆,皮層下梗死更多見MCA閉塞患者.
목적 탐토대뇌중동맥(MCA)구뇌경사자공진확산가권성상(DWI)성상병조분포특점급여기공혈동맥협착정도적관계.방법 회고성적분석경로뇌자공진성상(MRI)적DWI서렬진단적급성뇌경사,선택병조위우MCA분포구,차완선기공혈동맥검사,포괄두경부CTA,혹로뇌MRA가경부혈관초성적환자108례,배제심원성전새、특수혈관병변도치적뇌경사.장경사안조부위분위강극형경사(SSSI)、피층하경사(SI)화혼합형경사(MI),공혈동맥분위정상、경도(50％)、중도(50％)화폐새.비교불동류형경사조적공혈동맥협착적발생솔.결과 각충경사류형적발생솔지간차이무통계학의의(x2=1.08,P＞0.05).단순MCA병변자53례(53/108,49.1％),단순ICA병변자28례(28/108,25.9％),단순MCA병변고우단순ICA병변(x2=12.35,P＜0.01).동측혈관정상자이LI류형적경사다견,이단순ICA병변자이MI류형적경사다견(x2=10.22;10.54,P＜0.01)；삼충경사류형재단순MCA병변환자중차이무통계학의의(x2=0.25,P＞0.05)；재단순MCA병변자중,SI경사류형다견우MCA폐새환자(x2=7.45,P＜0.05).LI경사류형다견우MCA경도혹중도협착환자(x2=6.39,P＜0.05).결론 결합DWI화상응혈관검사대우명학MCA구동맥죽양경화성뇌경사적병인화궤제유일정방조.기저절구적강극경사,상응혈관검사정상제시소혈관병적가능대；MCA존재일정협착칙가능시천지수루조성；ICA병변다루급피층,포괄피층형분수령구경사；이불동정도적MCA병변기경사형태몰유본질구별,피층하경사경다견MCA폐새환자.
Objective To investigate the relationship between infarction distribution patter in diffusion-weighted imaging(DWI) in middle cerebral artery(MCA) territory and stenosis of arteries supplied.Methods With exclusion of cardioembolism and specific artery diseases,108 patients with cerebral infarction of the unilateral MCA territory on DWI were selected and their artery supply were determined by CTA or MRA and B ultrasound.The infarction pattern in MCA territory were divided into SSSI,SI and MI.The stenosis of artery was divided into normal,mild,severe and occlusion.The degree of stenosis or occlusion of ipsilateral artery were compared among three groups.Results In all patients,there is no significant difference of the incidence of infarction patterns among each group( x2 =1.08,P ＞ 0.05 ).There are 53 cases (49.0％ ) of simple MCA lesion,and 28 cases (25.9％) of simple ICA lesion.The incidence of simple MCA lesion is higher than simple ICA lesion(x2 =12.35,P ＜0.01).SSSI is more common in the normal ipsilateral artery group,but MI is more common in the simple ICA lesions group( x2 =10.22; 10.54,P ＜0.01).There is no difference among three kinds of infarction type in the simple MCA lesion group ( x2 =0.25,P ＞ 0.05).In simple MCA lesion group,SSSI is the most common type infarction in mild and severe stenosis group(x2 =6.39,P ＜ 0.05),but SI is more common in the occlusion group ( x2 =7.45,P ＜ 0.05 ).Conclusions In order to find out the etiology and mechanism of cerebral infarction,it is helpful to combined the DWI and ipsilateral artery examinations.If the arteries of MCA and ICA are normal,SSSI patients are most likely caused by small artery disease.If the MCA have some kind of narrow,this kind of infarction magbe caused by the damage of perforating artery.MI is more common in the simple ICA lesions group,especially involving cortex.SI is the most common in the MCA occlusion group.
