摘要目的：探讨高分辨磁共振（High-resolution magnetic resonance imaging，HR-MRI）不同成像序列对大脑中动脉M1段粥样硬化斑块的成分分析及显示能力，以利于序列的优化及诊断。方法：搜集2015年9月—2016年12月在我院诊断的大脑中动脉M1段动脉粥样硬化性狭窄患者40例，使用3．0T MRI扫描仪先行TOF横断面扫描，用重建3D-TOF成像确定斑块位置，行黑血MRI技术垂直于狭窄段进行T1WI、T2WI、PDWI及增强T1WI高分辨检查，计算各序列对斑块的脂核、出血、钙化显示的阴性及阳性例数，并统计各序列显示斑块各种成分的敏感性、特异性及K值。结果：在40例大脑中动脉M1段粥样硬化斑块中，发现32例斑块内有脂核，18例斑块内出血，22例斑块内钙化。增强T1WI显示斑块内脂核较好，敏感性为100%，特异性为87.5%，K值为0．918。T1WI显示斑块内出血最佳，敏感性为100％，特异性为86.4％，K值为0．922。斑块内钙化TOF显示能力最强，敏感性为100％，特异性为94.4％，K值为0．949。结论：增强T1WI显示斑块内脂核具有很高的敏感性及特异性，对于脂核的显示最佳。斑块内出血T1WI与TOF显示具有极好的一致性，而TOF能够准确判断斑块内钙化的存在。增强T1WI、T1WI和TOF三个序列相结合对斑块内脂核、出血及钙化能够很好地判别。
Abstract：Objective: To investigate the component analysis and display ability of atherosclerotic plaque in the M1 segment of middle cerebral artery by high-resolution MR imaging(HR-MRI) using different sequences, so as to facilitate sequence optimization and diagnosis. Methods: Forty cases of atherosclerotic stenosis in M1 segment of middle cerebral artery were enrolled from September 2015 to December 2016 in our hospital. 3.0T MRI scanner was used to performed the TOF cross section scan, and the location of plaque was determined by 3D-TOF reconstruction, T1WI, T2WI, PDWI and enhanced T1WI were performed perpendicular to the stenotic segment with black-blood MRI technology. The negative and positive cases of lipid core, hemorrhage and calcification of plaque were calculated, and the sensitivity, specificity and K value were analyzed statistically. Results: In 40 cases of atherosclerotic plaque in the M1 segment of middle cerebral artery, there were 32 cases of lipid core plaques, 18 cases of intraplaque hemorrhage, and 22 cases of calcified plaques. Enhanced T1WI that showed lipid core plaques was better, the sensitivity was 100%, specificity was 87.5% and the K value was 0.918. T1WI was the best sequence for demonstrating plaque hemorrhage, the sensitivity was 100%, the specificity was 86.4% and the K value was 0.922. TOF was the best for calcified plaque, the sensitivity was 100%, specificity was 94.4% and the K value was 0.949. Conclusion: Enhanced T1WI has high sensitivity and specificity for displaying lipid core plaques, which is the best display for the lipid core. T1WI and TOF that showed intraplaque hemorrhage was consistent, and TOF could accurately detect plaque calcification. The combination of three sequences of enhanced T1WI, T1WI and TOF can identify the lipid core, hemorrhage and calcification in the plaque.
范存雷，孙艳华，陈少武，赵廷超，杨 明，张潇斐，李飞龙，陈亚磊. 3.0T高分辨磁共振不同成像序列对大脑中动脉粥样硬化斑块成分分析[J]. 中国临床医学影像杂志, 2018, 29(4): 234-237.
FAN Cun-lei, SUN Yan-hua, CHEN Shao-wu, ZHAO Ting-chao, YANG Ming, ZHANG Xiao-fei, LI Fei-long, CHEN Ya-lei. Analysis of atherosclerotic middle cerebral artery plaque components by high-resolution MR imaging. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(4): 234-237.
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