高分辨磁共振成像与超声检查对颈动脉粥样硬化斑块的诊断价值

发布时间：2018-01-12 12:37

本文关键词：高分辨磁共振成像与超声检查对颈动脉粥样硬化斑块的诊断价值　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨高分辨磁共振成像与超声检查对颈动脉粥样硬化斑块的诊断价值。方法:筛选经超声显示为颈动脉狭窄的患者40例(男性23例,女性17例)平均年龄(65士10)岁,其中年龄70岁1例;颈内动脉、颈外动脉、颈总动脉共240支血管行颈动脉分叉部行高分辫颈动脉斑块MRI多序列扫描,探究颈动脉硬化斑块组成、斑块类型、管腔狭窄;比较高分辨磁共振与颈部超声检查对颈动脉斑块形态、组成、易损性及血管腔狭窄程度等方面的敏感性、准确性。排除标准:研究对象若满足以下其中一条时,则不能入选该研究:1.患有严重心功能不全或心衰,急性冠状血管供血不足及不稳定型心绞痛等,心肌梗死,控制不佳的心律失常(房颤);2.肝脏、肾脏功能不全(血清肌酐178μmol/L,GFR29ml/min;肝转氨酶2倍正常值上限);3.既往有脑出血病史;4.既往有抽搐、癫痫及肌病史;5.体内装有不适合进行磁共振检查的金属异物或起搏器等;既往有精神障碍及幽闭恐惧患者。结果:1.高分辨磁共振血管壁成像能清晰显示动脉硬化斑块组成、性质,经对符合研究要求患者HR-MRI图像进行详细分析显示主要表现为颈动脉管壁环形或偏心性管壁增厚、及斑块内部多种不同信号等影像学改变,颈动脉环形或偏心性管壁增厚等形态学改变与颈动脉超声检查相近,因病变内部成分混杂多样,超声表现为斑块回声均质和不均质改变,MRI信号表现差异较大,不同信号特征所反映不同病理组成成分,斑块内部新近出血在呈不规则高信号,纤维帽完整时在3D-TOF上显示为线样低信号带,在余序列上呈等或较高改变,发生破溃时,可表现为低信号带中断或缺乏,脂质在3D-TOF像上呈等信号,质子、T1加权上多呈等低信号,T2加权呈稍低信号改变。2.HR-MRI与颈动脉超声检查对斑块性质及动脉管腔狭窄程度的比较2.1 HR-MRI和颈动脉超声检查判别血管狭窄水平分级:HR-MRI扫描判别血管狭窄水平轻度、轻中度、重度、完全闭塞分别为12根、42根、16根、4根;颈动脉超声检查判别血管狭窄水平轻度、轻中度、重度、完全闭塞分别为13根、40根、17根、4根。评估管腔狭窄程度方面两种影像学检查手段相比,c2=0.008,P0.05,差异无统计学意义(P0.0 5)。2.2颈动脉二维超声检查显示,动脉粥样硬化斑块分为规则型(回声均质)、不规则型和溃疡型(回声不均),其中规则型(回声均质)近似于磁共振II和III型,而不规则型和溃疡型(回声不均)斑块近似于磁共振IV-VI型,HR-MRI检出颈动脉易损斑块38处,其中颈动脉超声检出26处,c2=4.00,P0.05,差异有统计学意义(P0.05)见表5,后经HR-MRI证实12处可疑病变为易损斑块,对易损斑块检出HR-MRI较超声敏感。3.各型斑块的分布:40例HR-MRI图像质量均符合本次研究的标准要求,显示动脉粥样硬化斑块共74处,其中I-II型、III型、IV-V型、VI型、VII-VIII型分别为12.1%,23.0%,21.6%,29.7%,13.5%。颈动脉3个不同部位各型斑块的分布见表3。统计结果显示颈动脉3个部位易损斑块与稳定斑块在的分布c2=11.25,P0.05,差异无统计学意义(c2检验,P0.05)见表4。结论:1.高分辨MRI能清晰显示颈动脉粥样硬化斑块组成成分、管腔狭窄水平,判断斑块易损性。2.高分辨MRI对颈动脉粥样硬化斑块性质方面较超声检查具有明显优越性。
[Abstract]:Objective: To explore the value of high resolution magnetic resonance imaging and ultrasonography in diagnosis of carotid atherosclerosis. Methods: screening ultrasound showed 40 cases of carotid artery stenosis patients (23 males, 17 females) with an average age of (65 + 10) years old, the age of 70 in 1 cases; internal carotid artery, external carotid artery the common carotid artery, 240 vessels for carotid bifurcation for high-resolution carotid plaque MRI sequence scanning, explore the carotid plaque, plaque type, luminal stenosis; comparison of high resolution magnetic resonance imaging and neck ultrasonography on carotid plaque morphology, sensitivity, vulnerability and vascular stenosis degree the accuracy of the research object. Exclusion criteria: if it satisfies the following one, is not included in the study: 1. patients with serious cardiac dysfunction or heart failure, acute coronary vascular insufficiency and unstable angina, myocardial infarction, control Poor arrhythmia (atrial fibrillation); 2. liver and kidney dysfunction (serum creatinine 178 mol/L, GFR29ml/min; liver transaminase is 2 times the upper limit of normal); 3. patients with cerebral hemorrhage; 4. patients with convulsions, epilepsy and myopathy history; 5. are installed in the body is not suitable for magnetic resonance examination of metallic foreign body or had a pacemaker; mental disorders and claustrophobic patients. Results: 1. high resolution magnetic resonance imaging can clearly display the vascular wall plaque composition, properties, to meet the requirements of HR-MRI patients by image analysis showed in detail mainly for the carotid artery wall or eccentric annular wall thickness changes and plaque a variety of different signal imaging, carotid artery wall thickening or eccentric annular morphological changes and carotid artery ultrasonography is similar, because the lesion internal components of hybrid diversity, ultrasound showed homogeneous and heterogeneous changes in plaque echo MRI, the difference signal is large, different signal characteristics reflect different pathological components, internal hemorrhage in recent plaques showed irregular high signal integrity of the fibrous cap when displayed on the 3D-TOF line with low signal, a change in the sequence or higher than that burst, showed low signal interrupt or lack of lipid were isointense on 3D-TOF like proton weighted multi T1 showed low signal, T2 weighted.2.HR-MRI showed slightly low signal change and examination of carotid artery ultrasound for degree of plaque and artery stenosis is 2.1 HR-MRI and carotid ultrasound classification of vascular stenosis level: HR-MRI scanning and discrimination vessels the level of mild stenosis, mild to moderate and severe occlusion, respectively 12, 42, 16, 4; ultrasound examination of carotid stenosis level distinguish mild, mild to moderate and severe occlusion, respectively 13, 40, 17, 4. Assessment of stenosis of two kinds of imaging methods compared to c2=0.008, P0.05, the difference was not statistically significant (P0.0 5).2.2 carotid ultrasound examination showed that atherosclerotic plaques were divided into regular (homogeneous echo), irregular type and ulcerative type (uneven echo), which rules (homogeneous echo approximation) in magnetic resonance II and III type, irregular type and ulcerative type (uneven echo) plaques similar to magnetic resonance IV-VI, HR-MRI detection of carotid artery plaque 38, carotid artery ultrasound detected 26, c2=4.00, P0.05, and there was statistically significant difference (P0.05) see Table 5, after HR-MRI confirmed 12 suspicious lesions of vulnerable plaque, the plaque detection distribution of HR-MRI ultrasonic sensitive.3. various types of plaque in 40 cases of HR-MRI image quality can meet the requirements of the standard, display a total of 74 atherosclerotic plaque, including type I-II, type III, type IV-V, VI Type, type VII-VIII were 12.1%, 23%, 21.6%, 29.7%, the distribution of 13.5%. of carotid artery in 3 different parts of various types of plaques in table 3. statistical results show that the distribution of carotid artery c2=11.25, 3 parts of vulnerable plaques and stable plaques in P0.05, there was no statistically significant difference (C2 test, P0.05) conclusion: see table 4. 1. high resolution MRI can clearly display the carotid atherosclerotic plaque composition, stenosis level, judge MRI on the properties of carotid atherosclerotic plaque with ultrasound has obvious advantages of high resolution.2. plaque vulnerability.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445;R543.4

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