刘斌　丁长青　罗慧

[摘要] 目的 探讨单侧大脑中动脉主干闭塞所致脑梗死的MRI及MRA表现。 方法 回顾性分析我院2017年1～12月收治的36例单侧大脑中动脉主干闭塞所致脑梗死患者的临床及影像学资料。所有患者均在发病3 d内行MRI检查，病程中均有MRA及CT检查资料。 结果 36例患者均见单侧大脑中动脉供血区较大片状T1WI低、T2WI及FLAIR高信号、DWI高、ADC低信号，以DWI序列显示最佳。4例FLAIR序列可见患侧大脑中动脉血管高信号征，10例可见远段FLAIR血管高信号征（FLAIR vascular hyperintensity，FVH）。3D-TOF MRA均可见责任侧大脑中动脉主干的闭塞、远侧侧支循环稀疏或缺乏。随访中脑梗死呈进展型12例，其中5例伴恶性脑水肿。 结论 MRI尤其是DWI序列可早期诊断大脑中动脉闭塞所致的梗死，MRA可显示大脑中动脉的狭窄、闭塞，影像学随访可评价疾病进展与否。

[关键词] 大脑中动脉闭塞；脑梗死；MRI；MRA；随访

[中图分类号] R743.3 [文献标识码] B [文章编号] 1673-9701（2018）20-0126-05

MRI and MRA manifestations of cerebral infarction caused by unilateral central cerebral artery occlusion

LIU Bin1 DING Changqing2 LUO Hui2 YUAN Zhengguang1

1.Department of Neurology， Feng County Peoples Hospital in Jiangsu， Feng County 221700， China； 2.Department of Imaging， Feng County Peoples Hospital in Jiangsu， Feng County 221700， China

[Abstract] Objective To investigate the MRI and MRA manifestations of cerebral infarction caused by unilateral central cerebral artery occlusion. Methods The clinical and imaging data of 36 patients with cerebral infarction caused by unilateral central cerebral artery occlusion who were admitted to our hospital from January to December 2017 were retrospectively analyzed. All patients were given MRI examination within 3 days after onset. MRA and CT examination data were included in the course of the disease. Results There were a large patchy areas of low T1WI， high T2WI and FLAIR signals， high DWI， and low ADC in unilateral central cerebral artery blood supply area in 36 patients， and the DWI sequence was the best. Signs of ipsilateral central cerebral artery vascular hyperintensity were found in FLAIR sequence in 4 cases. The FLAIR vascular hyperintensity（FVH） at distal segment was found in 10 cases. Occlusion of the responsible main central cerebral artery， sparse or lacking distal collateral circulation were seen by 3D-TOF MRA. During follow-up visit， 12 cases of cerebral infarction were progressive， of which 5 cases showed malignant brain edema. Conclusion MRI， especially DWI sequences， can be used to early diagnose cerebral infarction caused by central cerebral artery occlusion. MRA can show the central cerebral artery stenosis and occlusion， and imaging follow-up can evaluate the disease progression.

[Key words] Central cerebral artery occlusion； Cerebral infarction； MRI； MRA； Follow-up visit

大腦中动脉（middle cerebral artery，MCA）供血区脑梗死临床极为常见，但多为小分支血管的梗死。临床上以单侧MCA主干闭塞所致的脑梗死并不常见，若为伴恶性脑水肿（malignant brain edema，MBE）的进展性梗死，可致脑疝或死亡等严重不良结局[1]。目前直接确诊MCA闭塞主要依赖于DSA、CTA及MRA等影像学检查手段。常规MRA具有无创、无电离辐射、无需使用造影剂、相对价格低廉的优势，在临床上具有较大应用优势。现回顾性分析我院2017年1～12月收治的36例单侧大脑中动脉主干闭塞所致脑梗死患者的临床及影像学资料，旨在探讨MRI及MRA的诊断价值。

1 资料与方法

1.1一般资料

36例患者中，男12例，女24例，年龄41～89岁，平均（72.24±3.85）岁。……