基于磁共振血管成像分析椎基底动脉交界区开窗与脑梗死相关性研究

[中文引用][英文引用]

 [摘要] 目的 基于MR血管成像(MRA)的椎基底动脉交界区开窗的血液流变特性研究，探讨脑梗死与椎基底动脉交界区开窗的关系。 方法 收集2018年1月至2022年1月于牡丹江医学院附属红旗医院诊断为椎基底动脉交界处开窗的60例患者，依据有无脑梗死情况分为脑梗死组及对照组各30例，以椎基底动脉MRA图像为基础构建三维几何模型，应用计算流体力学方法进行数值模拟分析，获得血流速度(V)、震荡剪切系数（OSI）及管壁壁面剪切力（WSS）。 结果 脑梗死组V、OSI及WSS均高于对照组，差异有统计学意义（P<0.05）。脑梗死组高V集中在单侧椎动脉、开窗起始部、基底动脉及大脑后动脉处，另开窗起点处可见紊流；高OSI集中在开窗动脉附近；高WSS集中于单侧椎动脉、开窗起点处及双侧大脑后动脉，与高V、高OSI区域重合。上述血管区域易导致动脉内膜增生和动脉粥样硬化，增加脑梗死发生可能。 结论  脑梗死组的椎基底动脉交界区开窗畸形具有高V、高OSI及高WSS，多集中于开窗处及基底动脉段，临床上应着重关注该区域，及时采取治疗措施。

 [Abstract]  Objective  To investigate the relationship between cerebral infarction and vertebrobasilar junction fenestration based on the study of hemorheological characteristics of vertebrobasilar junction fenestration by MR angiography (MRA). Methods  Sixty patients with vertebrobasilar junction fenestration diagnosed in Hongqi Hospital of Mudanjiang Medical University from January 2018 to January 2022 were collected. The patients were divided into cerebral infarction group (n=30) and control group (n=30) according to the presence or absence of cerebral infarction. Three-dimensional geometric models were constructed based on vertebrobasilar MRA images. Numerical simulation analysis was performed using computational hydrodynamic methods to obtain the results of velocity (V), oscillatory shear index (OSI) and wall shear stress (WSS). Results  The V, OSI and WSS of the cerebral infarction group were higher than those of the control group, with statistically significant differences (P<0.05). In the cerebral infarction group, high V was concentrated in unilateral vertebral artery, origin of fenestration, basilar artery and posterior cerebral artery, and turbulent flow was observed at the origin of fenestration. High OSI was concentrated near fenestration artery. High WSS was concentrated in unilateral vertebral artery, origin of fenestration and bilateral posterior cerebral artery, which coincided with high V and high OSI area. The above vascular areas easily led to arterial intimal hyperplasia and atherosclerosis, increasing the possibility of cerebral infarction. Conclusion  The fenestration of vertebrobasilar junction in the cerebral infarction group has high V, high OSI and high WSS, which are mostly concentrated in the fenestration and basilar artery segment. Clinically, it is important to focus on this area and take timely treatment measures.