CAJ | 학술논문

目的探讨急性期脑梗死患者弥散加权成像(DWI)出现皮质层状坏死(CLN)表现的临床意义.方法回顾性分析41例连续积累的急性大脑中动脉(MCA)供血区脑梗死患者的病例资料,入选病例均在发病后48h内行DWI、MRA及颈部动脉彩超检查,除外心源性栓塞性脑梗死,其中5例行主动脉弓上及全脑DSA检查.分为CLN阳性组和CLN阴性组,比较2组的病灶同侧MCA、ICA颅内段和颅外段(责任供血大动脉)狭窄或闭塞的发生率.结果 9例患者DWI出现CLN表现,其中7例存在责任供血动脉中度及以上狭窄,单纯表现为CLN信号改变的5例均为重度狭窄或闭塞.32例患者DWI未显示CLN信号改变,其中12例存在责任供血动脉中度及以上狭窄.病灶同侧ICA颅内段和(或)MCA中度及以上狭窄或闭塞方面,2组差异有统计学意义(55.6％与21.9％,x2=3.85,P＜0.05).CLN信号改变与ICA颅内段和(或)MCA中度及以上狭窄呈正相关(OR值为4.5,95％ CI:1.0～20.2).无狭窄方面相比CLN阴性组显著高于阳性组,但2组间差异无统计学意义(0与31.3％,校正x2=0.32,P＞0.05).结论急性期脑梗死患者磁共振DWI序列如出现CLN表现,提示极有可能存在责任供血大动脉的中度及以上狭窄或闭塞,应进一步评估血管状况.
목적 탐토급성기뇌경사환자미산가권성상(DWI)출현피질층상배사(CLN)표현적림상의의.방법 회고성분석41례련속적루적급성대뇌중동맥(MCA)공혈구뇌경사환자적병례자료,입선병례균재발병후48h내행DWI、MRA급경부동맥채초검사,제외심원성전새성뇌경사,기중5례행주동맥궁상급전뇌DSA검사.분위CLN양성조화CLN음성조,비교2조적병조동측MCA、ICA로내단화로외단(책임공혈대동맥)협착혹폐새적발생솔.결과 9례환자DWI출현CLN표현,기중7례존재책임공혈동맥중도급이상협착,단순표현위CLN신호개변적5례균위중도협착혹폐새.32례환자DWI미현시CLN신호개변,기중12례존재책임공혈동맥중도급이상협착.병조동측ICA로내단화(혹)MCA중도급이상협착혹폐새방면,2조차이유통계학의의(55.6％여21.9％,x2=3.85,P＜0.05).CLN신호개변여ICA로내단화(혹)MCA중도급이상협착정정상관(OR치위4.5,95％ CI:1.0～20.2).무협착방면상비CLN음성조현저고우양성조,단2조간차이무통계학의의(0여31.3％,교정x2=0.32,P＞0.05).결론 급성기뇌경사환자자공진DWI서렬여출현CLN표현,제시겁유가능존재책임공혈대동맥적중도급이상협착혹폐새,응진일보평고혈관상황.
Objective To evaluate the clinical significance of cortical laminar necrosis (CLN) on diffusion-weighted imaging at acute stage of cerebral infarction.Methods 41 patients were retrospectively investigated who were diagnosed acute cerebral infarction in area of middle cerebral artery,and they got diffusion weighted imaging ( DWI ),magnetic resonance angiography ( MRA ) and colored ultrasonic inspection of cervical arteries within 48 hours after onset,with exclusion of cardioembolism,and 5 patients also had digital subtraction angiography (DSA).The patients were classified into CLN positive group or negative group.The stenosis or occlusion of ipsolateral MCA,intracranial and extracranial ICA were compared between the two groups.Results 9 patients'DWI had CLN,among whom 7 patients present moderate or more severe stenosis of feeding artery,and 5 patients who only had CLN signal presented severe stenosis or occlusion.32 patients'DWI had not CLN,among whom 12 patients present moderate or more severe stenosis of feeding artery.The CLN positive group had a high incidence of ipsilateral intracranial ICA and(or) MCA moderate or severe stenosis or occlusion(55.6％ vs 21.9％,x2 =3.85,P ＜ 0.05 ).The 5 patients who only had CLN signal had ipsilateral feeding artery severe stenosis.A positive correlation was found between CLN and moderate or severe stenosis or occlusion of ipsilateral intracranial ICA and(or) MCA(OR:4.5,95％ CI:1.0 ～ 20.2).Conclusion Patients with acute cerebral infarction and CLN on DWI were more likely to suffer from moderate or severe stenosis or occlusion of feeding large artery,and these patients should be evaluated vessel condition.