卢晔芬，邱伟文，曾婷婷，程伟进，陈建军，饶杰

（1.丽水市中心医院 神经内科，浙江 丽水 323000；2.丽水市人民医院 神经内科，浙江 丽水323000）

3.0T高分辨率磁共振成像对脑桥旁正中梗死的诊断价值

卢晔芬1，邱伟文2，曾婷婷1，程伟进1，陈建军1，饶杰1

（1.丽水市中心医院 神经内科，浙江 丽水 323000；2.丽水市人民医院 神经内科，浙江 丽水323000）

目的：应用3.0T高分辨磁共振成像（HRMRI）对基底动脉粥样硬化斑块进行分析在脑桥旁正中梗死（PPI）中的诊断价值。方法：连续入组孤立PPI患者53例，行头颅磁共振血管成像（MRA）和HRMRI检查，比较两者基底动脉狭窄检出率。应用HRMRI分析基底动脉粥样硬化斑块的分布、成分特点及重构指数（RI）等。结果：MRA上发现19例有基底动脉狭窄（占35.84%），HRMRI发现34例患者有基底动脉狭窄（占64.15%），2者差异有统计学意义（P＜0.05）。HRMRI发现44例患者有基底动脉粥样硬化斑块（占83.01%），斑块位于前壁、左壁居多，偏心斑块占90.91%，不稳定斑块占59.09%。阴性重构15例，无重构12例，阳性重构17例。13例可见斑块位于PPI责任血管的穿支动脉口。结论：HRMRI对基底动脉狭窄的检出率高，PPI患者基底动脉斑块大多分布前壁和左壁，斑块不稳定性高。HRMRI对基底动脉斑块分析在PPI中具有较高诊断价值。

高分辨磁共振成像；脑桥旁正中梗死；动脉粥样硬化；基底动脉；重构指数

Abstract: Objective:To apply 3.0T high-resolution MRI (HRMRI) in the diagnosis of basilar atherosclerotic in paramedian pontine infarction (PPI).Methods:Consecutive 53 patients with PPI were performed MRA and HRMRI, compared the differences in assessing the basal artery stenosis between the two methods. The distribution, composition features and remodeling index of basilar artery atherosclerosis were observed using HRMRI,the correlation of basilar artery atherosclerosis and cerebral infarction were analyzed.Results:Nineteen cases of basal artery stenosis deteeted by MRA (35.84%) compared with 34 cases detected by HRMRI (64.15%), there were significant statistically differences (P＜0.05). Forty-four cases of basilar artery atherosclerosis were detected by HRMRI (83.01%). The basilar artery atherosclerosis were mainly distributed in the front and left sites, the percentage of eccentric plaques was 90.91% and unstable plaque was 59.09%. Negative remodeling was found in 15 patients, intermediate remodeling in 12 patients, and positive remodeling in 17 patients. The basilar artery plaques at or near the origin of the penetrating artery in 13 cases.Conclusion:HRMRI is more sensitive to detect basilar artery stenosis compared with MRA. The basilar artery atherosclerosis mainly distributes in the front and left sites in PPI patients, and plaque instability is high incidence. Morphological analysis of basal artery plaque using HRMRI has high value in patiens of PPI.

Key words:high-resolution MRI; paramedian pontine infarction; atherosclerosis; basilar artery; remodeling index

脑桥旁正中梗死（paramedian pontine infarction，PPI）是指脑桥旁正中部位发生的梗死，大多因脑桥旁正中动脉（基底动脉穿支）发生闭塞所致。常规血管影像检查方法，如磁共振血管成像（magnetic resonance angiography，MRA）、CT血管成像（CT angiography，CTA）只能显示管腔的内部情况，无法显示管壁结构；当动脉粥样硬化未引起明显血管狭窄时，可能遗漏病变。……