| ObjectiveTo analyze the intracranial vascular plaque characteristics in different subtypes of intracranial atherosclerotic ischemic stroke in CISS classification by high-resolution magnetic resonance vessel wall imaging(HRMRVWI).MethodsA retrospective analysis was performed on 41 patients with clinically diagnosed symptomatic ischemic stroke.All patients were underwent head HRMRVWI(plain scan+enhanced)and routine MRI examination,including 17 patients in the parent artery(plaque or thrombus)occluding penetrating artery(PAOPA)group,20 patients in the artery-to-artery embolism(ATAE)group,4 patients in the hypoperfusion/impaired emboli clearance(HP/IEC)group and 0 patient in the multiple mechanism(MM)group.Due to the low number of cases in the hypoperfusion/impaired emboli clearance group and the multiple mechanism group,the results will be biased,so statistical analysis was performed only for the parent artery(plaque or thrombus)occluding penetrating artery group and artery-to-artery embolism group.Basic clinical characteristics,the overall distribution and enhancement characteristics of plaques in the whole brain between the two groups were analyzed and compared,as well as the location,distribution,morphology,load,signal,thickness,enhancement characteristics of plaques in the responsible vessels and stenosis degree,reconstruction characteristics of the responsible vessel lumen.Results(1)There were no significant differences between the two groups in basic clinical characteristics such as age,gender,whether accompanied by hypertension,hyperlipidemia,diabetes,smoking,the NIHSS score and statin use(p>0.05).(2)For the analysis of the overall distribution and enhancement characteristics of whole brain plaques,there was a significant difference in the incidence of plaque grade 2 enhancement(p<0.05),the ATAE group was higher than the PAOPA group(31.0%vs 19.7%),but no statistically significant differences in the number of whole-brain plaque,the distribution of the number of plaques in the anterior and posterior circulation and the cumulative score of whole brain plaque enhancement(p>0.05).(3)As for the distribution and location characteristics of the responsible plaques,the two groups of responsible plaques were mostly located in the Ml segment of the middle cerebral artery(75.0%vs 70.6%),and were mostly distributed in the anterior or superior wall of the vessels.(4)For responsible plaque characteristics and luminal analysis,ATAE group of plaque surface irregularity rate(65.0%vs 29.4%),plaque load(73.69± 12.13%vs 65.24± 11.57%)and the incidence of plaque grade 2 enhancement(80.0%vs 29.4%)were significantly higher than those of PAOPA group,and the differences between the two groups were statistically significant(p<0.05).In terms of the incidence of plaque grade 0 enhancement(10.0%vs 47.1%),the ATAE group was significantly lower than PAOPA group(p<0.05).There were no statistically significant differences between two groups in the eccentric distribution of plaques,the occurrence of high signal in plaques,the thickness of plaques,the degree of stenosis,and the way of reconstruction of responsible vessels(p>0.05).(5)For logistic regression analysis and receiver operating characteristic(ROC)curve analysis of patients in the artery-to-artery embolism group,the incidence of plaque grade 2 enhancement can be used as an independent risk factor for artery-to-artery embolism,OR value(Exp(B))and 95%CI is 10.494(1.394,78.996),area under curve of ROC(AUC)is 0.753.Conclusion1.Compared with the parent artery(plaque or thrombus)occluding penetrating artery group,the artery-to-artery embolism group has more plaque irregularities,higher plaque load,and higher incidence of plaque grade 2 enhancement,were mostly characterized by unstable plaques;2.The parent artery(plaque or thrombus)occluding penetrating artery group showed the stability of plaque characteristics;3、The incidence of plaque grade 2 enhancement has certain diagnostic value for artery-to-artery embolism cerebral infarction,and can be used as an independent risk factor for artery-to-artery embolism.ObjectiveTo analyze the characteristics of intracranial infarction and cerebral blood flow in patients with phlegm-dampness syndrome of subacute ischemic stroke by magnetic resonance three-dimensional arterial spin labeling(3D ASL)brain perfusion imaging and diffusion weighted imaging(DWI).MethodsA retrospective analysis was performed on 27 patients with clinical diagnosis of symptomatic ischemic stroke,including 14 cases of phlegm dampness syndrome as the main syndrome and 13 cases of non-phlegm dampness syndrome as the main syndrome(7 patients with qi deficiency as the main syndrome and 6 patients with blood stasis as the main syndromes,called qi deficiency and blood stasis syndrome group).All patients performed DWI,magnetic resonance angiography(MRA)and 3D ASL brain perfusion imaging.According to the distribution of the number of ischemic lesions in DWI images,it is divided into single infarcts and multiple infarcts.According to the size of the ischemic lesions,it is divided into lacunar infarction(infarct diameter≤15mm)and non-lacunar infarction(infarction diameter>15mm);and then the ADC value in core area of maximum infarction was measured.The 3D ASL brain perfusion raw data was used to calculate the global cerebral blood flow(CBF)map through the GE post-processing workstation ASL processing module,and the cerebral blood flow values of the core area of the largest infarction(infected side)and the mirror area(contralateral side)were measured,as well as the caudate nucleus,lenticular nucleus,dorsal thalamus,substantia nigra,red nucleus,and dentate nucleus,middle cerebral artery blood supply area(M1,M2,M3,M4,M5,M6),anterior cerebral artery blood supply area(A),posterior cerebral artery blood supply area(P),cerebellar hemisphere(Cb)cerebral blood flow values.Analyze and compare the differences between the two groups.Results(1)A high proportion of single infarcts were found in both groups.The proportion of non-lacunar cerebral infarctions(infarction diameter>15mm)in the phlegm-dampness syndrome group is higher than that in the qi deficiency and blood-stasis syndrome group(64.3%vs 15.4%),and the difference was statistically significant(p<0.05),for comparison of ADC values in the infarcted core area(0.65±0.18*10-3 vs 0.62±0.14*10-3)mm2/s,there was no significant difference between two groups(p>0.05).(2)For the analysis of cerebral blood flow,within the group comparison,the CBF value of the infarction core area of the two groups of patients with phlegm-dampness syndrome group and qi deficiency and blood-stasis syndrome group were significantly lower than the contralateral CBF value(28.04 ± 8.37 vs 40.78 ± 7.02,34.22± 6.47 vs 39.39 ± 6.99)[ml/(100 g·min)],the differences were statistically significant(p<0.05).In the comparison between the groups,the CBF value in the infarct core area was significantly different between two groups(p<0.05),and the phlegm-dampness syndrome group was significantly lower than the qi deficiency and blood stasis syndrome group(28.04±8.37 vs 34.22±6.47)[ml/(100 g·min)],there was no significant difference in CBF values in the mirror image area(contralateral)and other areas of the brain.Conclusion1.The infarct size and cerebral blood flow in the core infarct region can be used as objective imaging references for the diagnosis of phlegm and dampness syndromes in the subacute ischemic stroke.Patients with phlegm-dampness syndrome group had a higher proportion of non-lacunar cerebral infarction(infarct diameter>15mm),and cerebral blood flow in the core infarct area was lower than that in qi deficiency and blood stasis group.2.Magnetic resonance DWI and 3D ASL cerebral perfusion techniques can provide some help for the diagnosis of clinical TCM syndromes in patients with phlegm dampness syndrome of subacute ischemic stroke. |
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