摘要
目的探究3.0 T高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)对椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)合并后循环梗死的预测效能。材料与方法回顾性分析2021年5月至2024年6月我院收治的200例VBD患者的临床资料,均已接受HRMR-VWI检查。所有患者均随访至2025年3月,在随访期间有4例患者因个人原因失访,脱落率为2.00%。根据是否合并后循环梗死将患者分为研究组(合并后循环梗死,142例)及对照组(未合并后循环梗死,54例),分析HRMR-VWI指标对VBD合并后循环梗死的预测价值。根据血管腔狭窄程度将研究组分为轻度(25%≤被测血管狭窄率<50%)、中度(50%≤被测血管狭窄率<70%)及重度狭窄(被测血管狭窄率≥70%),分析HRMR-VWI指标与后循环梗死患者血管腔狭窄程度的关系。结果研究组最窄层面管腔面积小于对照组,管壁面积、斑块面积大于对照组,斑块负荷及重构指数高于对照组,差异具有统计学意义(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线显示,HRMR-VWI指标联合检测预测VBD合并后循环梗死的曲线下面积(area under the curve,AUC)大于各指标单独检测,差异具有统计学意义(P<0.05)。研究组甘油三酯、总胆固醇、低密度脂蛋白、载脂蛋白A1、纤维蛋白原水平高于对照组,高密度脂蛋白水平低于对照组,管腔面积<3.08 mm^(2)、管壁面积≥10.65 mm^(2)、斑块面积≥3.14 mm^(2)、斑块负荷≥0.74、重构指数≥1.01的人数比例高于对照组,差异具有统计学意义(P<0.05)。总胆固醇、载脂蛋白A1、纤维蛋白原水平升高及最窄层面管腔面积缩小、管壁面积缩小、斑块面积增大及斑块负荷和重构指数升高是VBD合并后循环梗死的危险因素(P<0.05)。研究组BA、VA不稳定斑块比例高于对照组,差异具有统计学意义(P<0.05)。VBD患者最窄层面血管面积、管腔面积与血管腔狭窄程度呈负相关,斑块面积、斑块负荷及重构指数与血管腔狭窄程度呈正相关(P<0.05)。结论3.0 T HRMR-VWI对VBD患者合并后循环梗死具有预测价值,且HRMR-VWI指标变化与患者并发后循环梗死有关。
Objective:To explore the predictive efficiency of 3.0 T high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)on vertebrobasilar dolichoectasia(VBD)with posterior circulation infarction.Materials and Methods:The clinical data of 200 patients with VBD in the hospital were retrospectively analyzed from May 2021 to June 2024.All patients received HRMR-VWI examination,and were followed up until March 2025.During follow-up,4 cases were lost to follow-up for personal reasons,with the shedding rate of 2.00%.The patients were divided into study group(with posterior circulation infarction,142 cases)and control group(without posterior circulation infarction,54 cases)according to whether they were complicated with posterior circulation infarction.The predictive value of HRMR-VWI indicators on VBD with posterior circulation infarction was analyzed.According to the degree of vascular stenosis,the patients in study group were classified into mild stenosis(25%≤measured vascular stenosis rate<50%),moderate stenosis(50%≤measured vascular stenosis rate<70%)and severe stenosis(measured vascular stenosis rate≥70%).The relationship between HRMR-VWI indicators and vascular stenosis degree in patients with posterior circulation infarction was analyzed.Results:The lumen area at the narrowest level in study group was smaller than that in control group while the vascular wall area and plaque area were larger than those in control group,and the plaque load and remodeling index were higher,with statistical differences(P<0.05).Receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of combined detection of HRMR-VWI indicators in predicting VBD with posterior circulation infarction was greater than that of single detection of each indicator,with a statistical significance(P<0.05).The levels of triglyceride,total cholesterol,low density lipoprotein,apolipoprotein A1 and fibrinogen in study group were higher while and the level of high density lipoprotein was lower than that in control group,and the proportions of patients with lumen area<3.08 mm^(2),vascular wall area≥10.65 mm^(2),plaque area≥3.14 mm^(2),plaque load≥0.74 and remodeling index≥1.01 were higher,with statistical differences(P<0.05).The increases of total cholesterol,apolipoprotein A1 and fibrinogen,reduction of lumen area at the narrowest level,reduction of vascular wall area,enlargement of plaque area and increases of plaque load and remodeling index were the risk factors of VBD with posterior circulation infarction(P<0.05).The proportions of BA and VA unstable plaques in study group were higher than those in control group,with statistical differences(P<0.05).In VBD patients,the blood vessel area and lumen area at the narrowest level were negatively correlated with the degree of vascular stenosis while the plaque area,plaque load and remodeling index were positively correlated with the degree of vascular stenosis(P<0.05).Conclusions:3.0 T HRMR-VWI has predictive value on VBD patients with posterior circulation infarction,and the changes of HRMR-VWI indicators are related to posterior circulation infarction in patients.
作者
孙瑞雪
常瑞亭
于天舒
王燕铭
康志雷
SUN Ruixue;CHANG Ruiting;YU Tianshu;WANG Yanming;KANG Zhilei(Imaging Center,Hengshui People's Hospital,Hengshui 053000,China;Department of Nuclear Medicine,Hengshui People's Hospital,Hengshui 053000,China)
出处
《磁共振成像》
北大核心
2025年第7期15-21,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
河北省医学科学研究课题计划项目(编号:20220470)。
关键词
高分辨率磁共振成像
血管壁成像指导
椎基底动脉延长扩张症
后循环梗死
预测价值
high-resolution magnetic resonance imaging
vessel wall imaging guidance
vertebrobasilar dolichoectasia
posterior circulation infarction
predictive value
