Department of Radiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Stroke Vasc Neurol. 2022 Oct;7(5):399-405. doi: 10.1136/svn-2021-001277. Epub 2022 Mar 9.
Haemodynamics around the middle cerebral artery (MCA) and lenticulostriate arteries is believed to play important roles in the vascular rupture and local haemodynamics is subject to vascular geometry. Nonetheless, the relationship between the geometric features of MCA and spontaneous basal ganglia intracerebral haemorrhage (ICH) has not been investigated. To examine the relationship between the MCA geometric features and spontaneous basal ganglia ICH.
This study was of retrospective and observational nature. The study recruited 158 consecutive hospitalised patients with consecutive CT-confirmed unilateral spontaneous basal ganglia ICH. Clinical data were extracted from electronic medical records, and imaging data were evaluated by two trained radiologists. The MCA-related geometric features were examined and their relationship with spontaneous basal ganglia ICH was analysed. Haemodynamic analyses under different MCA structural features were conducted.
Compared with the contralateral MCA, the ipsilateral MCA had greater M1 diameter ratio (proximal/distal) and a smaller M1/M2 angle and MCA bifurcation angle (p＜0.01). Imaging study showed differences in the MCA shape in both sides on coronal plane (p＜0.05). These MCA features were significantly correlated with the spontaneous ICH in basal ganglia. The greater M1 diameter ratio (proximal/distal), the inferior-oriented M1, the smaller M1/M2 angle and the superior-oriented M1 conditions increased the pressure, from high to low. The greater M1 diameter ratio (proximal/distal) and the inferior-oriented M1 increased the shear stress at the distal end of M1 segment.
The geometric features of MCA were significantly related to the spontaneous ICH in basal ganglia. The risk of haemorrhage, from high to low, included the greater M1 diameter ratio (proximal/distal), the inferior-oriented M1 (distal end), the smaller M1/M2 angle and the superior-oriented M1. Mechanistically, these vascular structural features contribute to increased vascular wall pressure and shear stress, which eventually lead to haemorrhage.
大脑中动脉（MCA）及其纹状体动脉周围的血液动力学被认为在血管破裂中起重要作用，而局部血液动力学受血管几何形状的影响。然而，MCA 的几何特征与自发性基底节区脑出血（ICH）之间的关系尚未得到研究。本研究旨在探讨 MCA 几何特征与自发性基底节区 ICH 的关系。
本研究为回顾性和观察性研究。共纳入 158 例连续住院的单侧 CT 证实的自发性基底节区 ICH 患者。临床资料从电子病历中提取，影像学资料由 2 名经过培训的放射科医生进行评估。检查 MCA 相关的几何特征，并分析其与自发性基底节区 ICH 的关系。在不同 MCA 结构特征下进行血液动力学分析。
与对侧 MCA 相比，同侧 MCA 的 M1 直径比（近端/远端）更大，M1/M2 角和 MCA 分叉角更小（p＜0.01）。冠状面影像学研究显示双侧 MCA 形态存在差异（p＜0.05）。这些 MCA 特征与基底节区自发性 ICH 显著相关。较大的 M1 直径比（近端/远端）、M1 向下倾斜、较小的 M1/M2 角和 M1 向上倾斜的情况会增加压力，压力由高到低。较大的 M1 直径比（近端/远端）和 M1 向下倾斜会增加 M1 段远端的剪切力。
MCA 的几何特征与基底节区自发性 ICH 显著相关。从高到低的出血风险包括较大的 M1 直径比（近端/远端）、M1 向下倾斜（远端）、较小的 M1/M2 角和 M1 向上倾斜。从机制上讲，这些血管结构特征导致血管壁压力和剪切力增加，最终导致出血。
