高分辨率核磁共振管壁成像技术在头颈动脉闭塞病因诊断中的应用价值

发布时间：2018-03-03 02:34

本文选题：动脉闭塞性疾病　切入点：高分辨率磁共振成像　出处：《中国脑血管病杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨高分辨率MRI(high-resolution MRI,HR-MRI)在头颈部动脉闭塞患者病因诊断中的价值。方法前瞻性连续纳入2015年12月至2017年2月首都医科大学宣武医院急性头颈动脉闭塞患者25例,采用32通道头颈联合专用线圈行头颈一体化HR-MRI成像,分析闭塞血管节段局部管壁特征和闭塞中远段腔内血栓信号特征。由2名神经内科医师结合纳入患者的临床病史、实验室检查、影像学检查对闭塞病因进行评价并作为参考标准,比较常规管腔成像技术与常规管腔成像联合HR-MRI在病因分类中的准确率。结果 (1)25例急性头颈动脉闭塞患者均完成HR-MRI检查,共诊断闭塞血管31段,其中常规管腔成像诊断了21段,常规管腔成像+HR-MRI诊断了30段;动脉硬化性闭塞24段(19例),动脉夹层性闭塞4段(4例),动脉炎性闭塞3段(2例)。(2)动脉硬化性闭塞患者中,闭塞节段近端管壁均可见偏心性增厚;动脉夹层性闭塞均见典型的双腔征或新月形高信号壁内血肿;血管炎性闭塞血管节段中可见长节段环形增厚及强化。(3)常规管腔成像技术与常规管腔成像联合HR-MRI对病因分类诊断的准确率分别为67.7%(21/31)和96.8%(30/31),差异有统计学意义(P0.01)。结论相较于常规管腔成像技术,头颈联合HR-MRI可显示闭塞起始段动脉管壁特征,对判读动脉粥样硬化、动脉夹层和动脉炎性病变等病因具有一定优势。
[Abstract]:Objective to evaluate the value of HR-MRI in the etiological diagnosis of head and neck artery occlusion (CAO). Methods 25 patients with acute head and carotid artery occlusion (CAO) in Xuanwu Hospital of Capital Medical University from December 2015 to February 2017 were included prospectively. 32 channel head and neck combined with special coil were used for head and neck integrated HR-MRI imaging to analyze the characteristics of local wall of occluded vascular segment and the characteristics of thrombus signal in middle and distal segment of occlusion. Two neurologists were combined with two neurologists in the clinical history of the patients. Laboratory examination, imaging examination to evaluate the etiology of occlusion and as a reference standard, The accuracy of conventional lumen imaging and conventional luminal imaging combined with HR-MRI in etiological classification was compared. Results all 25 patients with acute head and neck artery occlusion completed HR-MRI examination, and 31 segments of occluded vessels were diagnosed, among which 21 segments were diagnosed by conventional lumen imaging. In 30 patients with arteriosclerotic occlusion, 19 with arteriosclerotic occlusion, 4 with dissecting occlusion, 2 with inflammatory occlusion and 2 with arteriosclerotic occlusion, the proximal wall of the occluded segment was eccentrically thickened. Typical double-lumen sign or crescent hyperintense intramural hematoma was found in all patients with arterial dissecting occlusion. The accuracy of conventional lumen imaging and conventional lumen imaging combined with HR-MRI in the diagnosis of etiological classification was 67.7% 21 / 31) and 96.880% 30 / 31% respectively. The difference was statistically significant (P 0.01). Compared with conventional lumen imaging, The combination of head and neck combined with HR-MRI can show the characteristics of the artery wall in the initial segment of occlusion, which has a certain advantage in judging the causes of atherosclerosis, dissection and inflammatory diseases.
【作者单位】：首都医科大学宣武医院放射科;首都医科大学宣武医院神经内科;首都医科大学宣武医院神经外科;
【基金】：国家自然科学基金(81322022)
【分类号】：R445.2;R743.3

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