| Objective:To investigate the etiological distribution,risk factors and imaging features of different intracranial vascular plaques of intracranial anterior and posterior circulation artery stenosis by 3.0T high resolution magnetic resonance imaging(HR-MRI).Methods:262 patients with intracranial artery stenosis who underwent HRMRI examination in the Second Hospital of Hebei Medical University from 2019/11 to 2020/12 were selected,and their clinical and imaging data were recorded to explore the high-risk factors and etiological distribution of intracranial anterior and posterior circulation arterial stenosis.Compare the imaging manifestations of atherosclerotic plaques in different intracranial vessels and their correlation with laboratory indicators.Results:1.In 262 cases of intracranial artery stenosis,128 cases(45.86%)of the anterior circulation,56 cases(21.37%)of the posterior circulation,78 cases(29.77%)of the anterior and posterior circulation were involved,suggesting that the anterior circulation is common and the posterior circulation is rare.There were 180 males(68.7%)and 82 females(31.3%).Atherosclerosis was found in 210 cases(80.2%),angiitis of the central nervous system in 28 cases(10.7%),moyamoya disease/moyamoya syndrome in 21 cases(8.0%),and arterial dissection in 3 cases(1.1%).2.According to vascular involvement,210 cases of intracranial atherosclerosis were divided into anterior circulation in 82 cases(39.1%),posterior circulation in 50 cases(23.8%),and both anterior and posterior circulation in 78 cases(37.1%).The order from young to old was anterior circulation,posterior circulation,anterior and posterior circulation.3.Among the 159 patients with complete clinical data,46 cases(28.9%)were diabetes mellitus.The prevalence of anterior,posterior circulation and anterior and posterior circulation were 54.3%,30.4%,and 15.2%,respectively.There were significant differences in anterior circulation,anterior and posterior circulation involvement between the two groups.(χ~2=6.877Bonferroni correction,P=0.009).4.After adjusting the confounding factors of 276 plaques,it is concluded that plaque enhancement is an independent risk factor for recent infarction(P=0.042,OR 0.097 95%CI 0.10-0.916).It was found that middle cerebral artery(MCA)plaque level 2 enhancement,posterior cerebral artery(PCA),basilar artery(BA)plaque level 1,and level 2 enhancement are associated with recent infarction.(MCA P=0.019)(PCA P=0.011)(BA P=0.010).There was no correlation between plaque enhancement of VA and recent infarction(P>0.05).Plaque enhancement is weakly positively correlated with the degree of arterial stenosis(P=0.001).The higher the degree of plaque enhancement,the more severe the stenosis.5.Comparing the vascular remodeling methods in each group,the positive remodeling of the vertebral artery(94.4%)and the basilar artery(80.3%)was higher than that of the middle cerebral artery(36.7%),posterior cerebral artery(42.9%).The positive remodeling rate of vertebral artery is the highest.6.It was found that the alcohol drinkers in the non-positive remodeling group were about 3.3 times higher than those in the positive remodeling group,and the difference was statistically significant(P=0.016).The levels of lipoprotein an and homocysteine in positive remodeling group were higher than those in non-positive remodeling group(2.55±0.89 VS 2.24±0.89)、(2.75±0.60 VS 2.58±0.43 P<0.05).The positive remodeling group is older than the non-positive remodeling group(46.7±13.2 VS 52.7±14.0,P=0.006).7.276 plaques were divided into four groups:middle cerebral artery 101cases(36.59%),posterior cerebral artery 14 cases(5.07%),vertebral artery 90cases(32.62%),basilar artery 71 cases(25.72%).We found that only the middle cerebral artery plaque quadrant was associated with recent cerebral infarction.According to the quadrant,the plaques of middle cerebral artery were divided into five groups:superior,inferior,abdominal,dorsal and diffuse involvement.the infarction rate of abdominal and superior wall was higher than that of dorsal and inferior wall.(37.6%VS21.8%P=0.021)(8.9%VS5%P=0.013).8.There were statistical differences in the degree of stenosis in different plaque locations(χ~2=27.232 P<0.001).There was significant difference in the degree of stenosis between M1 distal segment and MCA,and between M1proximal segment and MCA.The M1 segment of the middle cerebral artery was the most easily involved,accounting for 84.2%(85 cases),and the proximal segment had the most plaques(34.7%).The stenosis degree of MCA is the heaviest in the whole process.71 cases of basilar artery plaques were divided into four groups:distal segment,middle segment,proximal segment and whole course involvement,with the most in distal segment(53.8%).The stenosis degree of plaque in proximal segment was more severe than that in distal segment and middle segment.In 14 cases of posterior cerebral artery plaque,P1 was involved in57.14%(7 cases),and there was no significant difference in the degree of stenosis among different plaques.Conclusion:1.Atherosclerosis is the most common cause of intracranial artery stenosis,followed by vasculitis,moyamoya disease and so on.The incidence of intracranial artery stenosis in males is higher than that in females.2.The etiological distribution of ICAD in the anterior and posterior circulation was different,and the proportion of ICAD in the posterior circulation was higher than that in the anterior circulation.Most of the anterior and posterior circulation were involved in ICAD and angiitis of the central nervous system,especially in ICAD.Angiitis of the central nervous system is more likely to involve the anterior circulation.3.There are differences in risk factors between anterior and posterior circulation stroke.There was a stronger correlation between diabetes and vascular stenosis in the anterior circulation,and the vascular involvement in the anterior circulation was earlier than that in the posterior circulation.4.Grade 2 enhancement of middle cerebral artery plaque,grade 1 and 2enhancement of posterior cerebral artery and basilar artery plaque are related to recent infarction.Vertebral artery plaque enhancement is not related to recent infarction.5.There is a weak positive correlation between the degree of intracranial ICAD stenosis and the degree of plaque enhancement.6.There was no significant correlation between plaque enhancement and laboratory indexes.7.The incidence of plaque in the ventral wall of the middle cerebral artery was the highest and the incidence of infarction in the superior wall was the highest.The plaque is most likely to involve the M1 segment of the middle cerebral artery,and the stenosis degree of the plaque involving the whole course of MCA is the most severe.Most of the basilar artery plaques were in the distal segment,and the stenosis in the proximal segment was more severe.The plaque of posterior cerebral artery was most frequently involved in the whole course of P1 segment. |
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