Zhongguo cuzhong zazhi (Nov 2023)
青年颅内动脉狭窄患者高分辨率磁共振血管壁成像的影像特征 The Imaging Features of High Resolution Magnetic Resonance Vessel Wall Imaging in Young Patients with Intracranial Artery Stenosis
Abstract
目的 探讨青年大脑中动脉（middle cerebral artery，MCA）狭窄的高分辨率磁共振血管壁成像（high resolution magnetic resonance vessel wall imaging，HRMR-VWI）的影像表现，比较不同病因所致的青年MCA狭窄的临床危险因素及影像特征。 方法 回顾性收集2017—2019年接受HRMR-VWI检查并符合入组标准的青年（16～45岁）患者76例。记录患者临床资料，分析其HRMR-VWI影像表现。根据出院诊断将患者分为动脉粥样硬化（atherosclerosis，AS）组及非AS组，比较不同病因所致MCA狭窄的影像特征，比较≤35岁患者 与>35～45岁患者的临床危险因素及影像特征。 结果 AS组49例[（35.76±5.29）岁，女5例]，非AS组27例[（31.07±7.47）岁，女16例]。AS组女性比例低于非AS组（10.2% vs. 59.3%，P35～45岁的患者高血压比例高于≤35岁患者（54.3% vs. 29.3%，P=0.027）。 结论 AS仍为中国青年人群MCA狭窄的常见病因；非动脉粥样硬化性疾病的青年女性比例更高。AS与非动脉粥样硬化性MCA狭窄的影像特征方面，管壁增厚方式及最大管壁厚度可以作为鉴别诊断的依据。 Abstract: Objective To investigate the imaging features of middle cerebral artery (MCA) stenosis in young patients on high resolution magnetic resonance vessel wall imaging (HRMR-VWI), and compare the clinical risk factors and imaging features of MCA stenosis in young patients with different causes. Methods Totals of 76 patients (16≤age≤45 years) with MCA stenosis who had HRMR-VWI examination and met the inclusion criteria between 2017 and 2019 were collected retrospectively. The clinical data of the patients were recorded, and the HRMR-VWI findings were analyzed. The patients were divided into atherosclerosis (AS) group and non-AS group based on their discharge diagnosis. To compare the imaging features of MCA stenosis caused by different causes in young patients, the clinical risk factors and imaging features were compared between the patients aged≤35 years and the patients aged over 35 years. Results There were 49 patients [(35.76±5.29) years old, with 5 females] in the AS group and 27 patients [(31.07±7.47) years old, with 16 females] in the non-AS group. The proportion of female patients in non-AS group was significantly higher than that in AS group (59.3% vs. 10.2%, P<0.001). The rate of smoking in the AS group was higher than that in the non-AS group (83.7% vs. 14.8%, P<0.001). The rate of hyperlipidemia in the AS group was higher than that in the non-AS group (63.3% vs. 18.5%, P<0.001). The difference was statistically significant. In the AS group, most cases showed eccentric wall thickening (44/49, 89.8%) on HRMR-VWI, while in the non-AS group, the majority were concentric wall thickening (23/27, 85.2%), there was a significant difference between the two groups (P<0.001). The statistical difference of maximum wall thickness between the AS group and the non-AS group was significant (P<0.001). Compared with patients aged≤35 years, patients aged over 35 years had a higher prevalence of hypertension (54.3% vs. 29.3%, P=0.027). Conclusions AS is the most common cause among young Chinese patients with MCA stenosis. The proportion of female with non-AS disease is higher. In terms of HRMR-VWI imaging features of AS and non-AS MCA stenosis, the wall thickening pattern and the maximum wall thickness can be used as the basis for differential diagnosis.
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