Study On The Relationship Between Middle Cerebral Artery Atherosclerotic Plaque And Lenticular Artery By HR-MRI

Objective: To evaluate the correlation between acute infarction which in lenticulostriate artery(LSA)and non-LSA supplying regions and atherosclerotic plaque characteristics in middle cerebral artery and the number of LSA by 3.0T high resolution magnetic resonance vascular wall imaging(HR-MRI VWI),and to understand the relationship between cerebral infarction volume and branch pattern of lenticular artery.Methods:From November 2019 to November 2020,A total of 55 patients with middle cerebral artery atherosclerotic plaque who underwent 3.0T HR-MRI examination in the Department of Medical Imaging,the 2nd Hospital of Hebei Medical University were collected.All patients received routine MRI examination,three-dimensional time-of-flight MR angiography(3D-TOF-MRA),diffusion-weighted imaging(DWI),HR-MRI T1 WI VISTA plain scan sequence and enhanced scan sequence.55 patients were divided into two groups according to DWI results: LSA supplying regions acute infarction group and non-LSA supplying regions acute infarction group.The clinical and middle cerebral artery atherosclerotic plaque characteristics of the two groups were compared and analyzed.LSA supplying regions acute infarction group were further divided into large infarction subgroup and small infarction subgroup according to the infarct volume.To analyze the correlation between infarct volume and LSA branch morphology.Results: 1.Among the 55 cases in the group,there were 35 males(63.6%)and 20 females(36.4%).The incidence rate of males was higher than that of females.There was no significant difference in age,sex,hypertension,hyperlipidemia,diabetes,hyperhomocysteinemia,smoking,drinking and other clinical risk factors between LSA supplying regions acute infarction group and non-LSA supplying regions acute infarction group.2.A total of 98 quadrants of middle cerebral artery plaques were involved in 55 patients(56 in LSA supplying regions acute infarction group,42 in non-LSA supplying regions acute infarction group).The proportion of plaques located at the superior wall(20 cases),inferior wall(15 cases),ventral wall(34 cases)and dorsal wall(29cases)of middle cerebral artery were 20.4%,15.3%,34.7% and 29.6%.In the LSA supplying regions acute infarction group,the most common plaque located at the dorsal wall(33.9%),followed by the superior wall(30.4%),the ventral wall(28.6%),and the inferior wall(7.1%).There was significant difference in plaque location between the two groups(14.269,P < 0.05).3.There were 19 cases of middle cerebral artery intra-plaque hemorrhage(IPH)in 55 cases(34.5%),there were 13 cases(48.1%)in LSA supplying regions acute infarction group,6 cases(21.4%)in non-LSA supplying regions acute infarction group.There was significant difference between the two groups(P=0.037).4.The plaques of middle cerebral artery in LSA supplying regions acute infarction group and non-LSA supplying regions acute infarction group were more common with grade 2 enhancement(P < 0.05).5.There was no significant difference in the degree of middle cerebral artery stenosis between LSA supplying regions acute infarction group and non-LSA supplying regions(P > 0.05).Positive remodeling was more common in LSA supplying regions acute infarction group and non-LSA supplying regions(P < 0.079),but the former has a high proportion of non-positive reconstruction.6.The number of LSA on the affected side in LSA supplying regions acute infarction group was lower than that in the non-LSA supplying regions acute infarction group,and the difference was statistically significant(4.00(2.00)vs 5.00(2.00),P=0.010).The number of LSA on the affected side in LSA supplying regions acute infarction group has decreased,compared with the healthy side,the difference was statistically significant(P < 0.05).7.27 cases of LSA supplying regions acute infarction group were divided into large infarct subgroup(n = 6)and small infarct subgroup(n = 21).There was no significant difference in plaque burden and the number of LSA trunks between the two groups(P >0.05).However,the number and index of responsible vascular branches in the infarct focus of the large infarct subgroup were higher than those of the small infarct subgroup,and the difference was statistically significant(6.00(3.5)vs1.00(0),P<0.001).The number of responsible vascular branches in infarction focus(r = 0.823;P < 0.001)and branch index(r = 0.763;P < 0.001)were positively correlated with infarction volume.Conclusion:1.The number of LSA on the affected side in LSA supplying regions acute infarction group was lower than that in the non-LSA supplying regions acute infarction group.In LSA supplying regions acute infarction group,plaque located at the dorsal and superior wall were more common,in non-LSA supplying regions acute infarction group,plaque located at the ventral and inferior wall were more common.The most common plaque in both groups was grade 2 enhancement.2.IPH of middle cerebral artery was more common in LSA supplying regions acute infarction group.3.The proportion of abnormal remodeling of middle cerebral artery stenosis was high in acute infarction group of LSA blood supply area.