摘要
目的探讨颈内动脉虹吸段形态及其相关危险因素与小动脉硬化型脑小血管病(aCSVD)患者脑血流灌注的关联,为aCSVD的病因识别提供影像学依据。方法纳入2022年3月至2024年6月在合肥市第一人民医院神经内科收治的、同时接受了多模态影像评估的aCSVD患者130例,收集其基线资料,利用头颅CT血管造影(CTA)后处理技术直观评价患者颈内动脉虹吸段的形态(分为U型63例、C型32例以及V型35例),结合头颈部CTA横断面半定量评估其钙化程度,最后利用磁共振动脉自旋标记技术测量患者脑血流灌注情况,采用方差分析以及多分类Logistic回归分析不同虹吸段形态、钙化程度及其危险因素与脑血流灌注的关系。结果单因素分析结果显示,颈内动脉虹吸段3种形态类型的患者在低密度脂蛋白胆固醇水平[U型(2.44±0.84)mmol/L,Ⅴ型(2.21±0.57)mmol/L,C型(2.89±1.07)mmol/L,F=5.578,P=0.005]、钙化程度[U型组63例中轻度钙化19例(30.15%),中度钙化20例(31.75%),重度钙化24例(38.10%);V型组35例中轻度钙化20例(57.14%),中度钙化10例(28.57%),重度钙化5例(14.29%);C型组32例中轻度钙化12例(37.50%),中度钙化14例(43.75%),重度钙化6例(18.75%);χ^(2)=13.092,P=0.011]、总aCSVD负荷[改良aCSVD负荷评分:U型4.00(1.00,4.00)分,Ⅴ型3.00(1.00,4.00)分,C型2.00(2.00,4.00)分,H=9.997,P=0.007]上差异有统计学意义。多分类Logistic回归分析发现,U型虹吸段患者的aCSVD总体负荷显著高于C型,回归系数为0.728,差异有统计学意义(OR=2.070,95%CI 1.026~4.178,P=0.042),同时U型虹吸段患者的全脑及白质脑血流量较C型和V型虹吸段降低,主要表现在双侧额上回、左侧眶部额中回、左侧直回区域(错误发现率校正,均P<0.05)。结论aCSVD患者脑血流影像学表现与颈内动脉虹吸段形状密切相关,U型虹吸段更容易导致血流动力学改变,出现全脑以及局部脑血流降低,且aCSVD总体负荷更高,在临床上对aCSVD的病因的判断有一定的参考价值。
ObjectiveTo explore the relationship between the morphology of the carotid siphon,its related risk factors,and cerebral blood flow perfusion in patients with arteriosclerotic cerebral small vessel disease(aCSVD),and provide imaging evidence for the etiology of aCSVD.MethodsA total of 130 aCSVD patients hospitalized in the Department of Neurology of the First People′s Hospital of Hefei from March 2022 to June 2024,all of whom underwent multimodal imaging assessments,were enrolled.The baseline data were collected,and the morphology of the carotid siphon was visually evaluated using post-processing of head and neck computed tomography angiography(CTA),which was categorized into U-type(n=63),C-type(n=32),and V-type(n=35).Calcification degree was semi-quantitatively assessed based on transverse CTA images.Cerebral perfusion was measured using magnetic resonance arterial spin labeling.The relationship between different siphon segment morphologies,calcification degrees,their risk factors,and cerebral blood flow perfusion was analyzed using analysis of variance and multinomial Logistic regression.ResultsUnivariate analysis of the 3 siphon types showed significant differences in low-density lipoprotein cholesterol[U-type(2.44±0.84)mmol/L,V-type(2.21±0.57)mmol/L,C-type(2.89±1.07)mmol/L,F=5.578,P=0.005],calcification degree[Among the 63 cases in the U-type group,19 cases(30.15%)had mild calcification,20 cases(31.75%)had moderate calcification,and 24 cases(38.10%)had severe calcification;among the 35 cases in the V-type group,20 cases(57.14%)had mild calcification,10 cases(28.57%)had moderate calcification,and 5 cases(14.29%)had severe calcification;among the 32 cases in the C-type group,12 cases(37.50%)had mild calcification,14 cases(43.75%)had moderate calcification,and 6 cases(18.75%)had severe calcification;χ2=13.092,P=0.011],and total aCSVD load[modified aCSVD load score:U-type 4.00(1.00,4.00),V-type 3.00(1.00,4.00),C-type 2.00(2.00,4.00),H=9.997,P=0.007].Multivariate Logistic regression revealed that patients with U-shaped siphons had a significantly higher overall aCSVD load than those with C-shaped siphons,with a regression coefficient of 0.728,and a statistically significant difference(OR=2.070,95%CI 1.026-4.178,P=0.042).Additionally,total brain and white matter cerebral blood flow were decreased in patients with U-type siphons compared to those with C-type and V-type,primarily involving bilateral superior frontal gyri,left orbital frontal gyrus,and left straight gyrus regions(false discovery rate correction,P<0.05).ConclusionsThe imaging manifestations of aCSVD are closely related to the shape of the internal carotid artery siphon.The U type siphon is more likely to lead to hemodynamic changes,resulting in decreased global and regional cerebral blood flow,and demonstrating a higher overall burden of aCSVD,which has certain clinical reference value for assessing the etiology of aCSVD.
作者
徐乔乔
周霞
杨佳佳
王硕
李明旭
席春华
朱小群
孙中武
Xu Qiaoqiao;Zhou Xia;Yang Jiajia;Wang Shuo;Li Mingxu;Xi Chunhua;Zhu Xiaoqun;Sun Zhongwu(Department of Neurology,the Third Affiliated Hospital of Anhui Medical University(the First People′s Hospital of Hefei),Hefei 230061,China;Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中华神经科杂志》
北大核心
2025年第8期837-845,共9页
Chinese Journal of Neurology
基金
国家自然科学基金(82401420)
安徽省自然科学基金(2108085MH274)
安徽省重点研发项目(202104j07020031)
安徽省科技厅临床医学研究转化项目(202204295107020024)
安徽省中医药传承创新项目(2024CCCX230)
合肥市卫健委应用医学项目(Hwk2023yb003)。
关键词
颈内动脉
脑小血管病
小动脉硬化
脑血流灌注
多模态影像
Carotid artery,internal
Cerebral small vessel diseases
Arteriosclerosis
Cerebral blood flow perfusion
Multimodal imaging
