高分辨MRI在大脑中动脉狭窄中的应用价值

发布时间：2018-03-27 20:39

  本文选题：高分辨磁共振成像　切入点：磁共振血管成像　出处：《郑州大学》2014年硕士论文

【摘要】：背景 短暂性脑缺血发作（transient ischemic attack, TIA）和脑梗死均隶属于缺血性脑血管病的范畴，发病率和致残率高，早期检出和治疗对患者病情的发展及预后有着重要意义。临床上常用的评估脑血管狭窄的检查手段有数字减影血管成像（digital subtraction angiography, DSA）、经颅多普勒超声（transcranial Doppler,TCD）、CT血管成像（CT angiography, CTA）以及磁共振血管成像（magneticresonance angiography, MRA）,但这些检查均存在这样或那样的不足。高分辨磁共振成像(high-resolution MRI，HRMRI)乃新兴的血管成像技术，不仅可以进行管腔成像，而且能够直观显示管壁结构，，目前已成熟应用于颅外颈动脉，可以准确评估颈动脉狭窄程度。近年来，随着高场强磁共振扫描仪的快速研发，HRMRI已日渐服务于颅内大动脉的研究。大脑中动脉（middle cerebral artery,MCA）为颈内动脉在颅内的直接延续，也是动脉粥样硬化等疾病最易侵及的血管，据报道，MCA粥样硬化性狭窄是国内引起缺血性脑血管病最常见的原因。那么，HRMRI在评估颅内大动脉狭窄方面的效力如何？另外，日常工作中，临床医生常遇到类似的问题，即严重程度匹敌的血管狭窄，部分患者出现了脑梗死，而另一部分患者则仅表现为TIA，该现象如何解释？究竟责任血管的狭窄程度在脑梗死患者与TIA患者中有无差异？ 针对上述提出的问题，本研究囊括两方面的内容，旨在探讨HRMRI对大脑中动脉(middle cerebral artery, MCA)狭窄或闭塞的诊断价值及MCA狭窄程度在动脉粥样硬化性狭窄引起的脑梗死和TIA中的差异。 目的 探讨HRMRI对大脑中动脉狭窄或闭塞的诊断价值。方法：搜集2012年10月-2013年10月我院介入科收治的55例经MRA或CTA证实为MCA M1段不同程度狭窄导致的短暂性脑缺血发作或脑梗死患者,其中男33例，女22例，年龄17-68岁，平均44.8岁。所有患者均行MRA、HRMRI和DSA检查,间隔时间平均3.4天。以DSA为金标准，结合MRA分析HRMRI对不同程度大脑中动脉狭窄的诊断价值。 结果 55例患者有55支大脑中动脉（MCA）在MRA、HRMRI和DSA上均发现管腔狭窄。其中有46支血管在HRMRI和DSA上测得的狭窄程度一致，符合率为83.6%（46/55）；MRA相较HRMRI诊断偏高率为61.8%(34/55)；HRMRI、DSA及MRA上测得的狭窄率分别为(70±17)%、(68±19)%、(85±20)%，HRMRI与DSA的狭窄率差异无统计学意义（Z=-1.192, P=0.233），与MRA的狭窄率差异有统计学意义（t=-6.604, P=0.000）。对HRMRI和DSA测得的MCA狭窄率进行相关性分析，r=0.893（P=0.000，Pearson法）；对HRMRI和MRA测得的MCA狭窄率进行相关性分析，r=0.602（P=0.000，Spearman法）。以DSA为金标准，HRMRI对大脑中动脉狭窄或闭塞诊断的Kappa值为0.773；以HRMRI为参考，MRA对大脑中动脉狭窄或闭塞诊断的Kappa值为0.355。 结论 HRMRI在评估大脑中动脉狭窄方面与DSA具有良好一致性，且能够避免MRA高估血管狭窄程度的缺陷，较真实的反映脑动脉狭窄情况。 目的 应用HRMRI研究责任血管为MCA的脑梗死和TIA患者MCA狭窄程度的差异。 方法 收集2012年4月-2013年9月连续入组经MRA或DSA证实的症状性MCAM1段动脉粥样硬化性狭窄患者91例，使用3.0T磁共振扫描仪对狭窄段进行HRMRI检查，测量并计算血管狭窄率，并加扫DWI、T2WI及黑水序列明确有无脑梗死。 结果 78例患者纳入最终分析，其中梗死患者46例，HRMRI上测得的狭窄率为0.72±0.21；TIA患者32例，HRMRI上测得的狭窄率为0.72±0.20，二者差异无统计学意义（t=-0.10, P=0.920.05）。 结论 责任血管为大脑中动脉的脑梗死与TIA患者，其大脑中动脉M1段狭窄程度无显著性差异，提示血管狭窄程度并非动脉粥样硬化性脑梗死发生的决定性因素。
[Abstract]:background
Transient ischemic attack (transient ischemic, attack, TIA) and cerebral infarction belongs to the category of ischemic cerebrovascular disease, high morbidity and disability rate, early detection and treatment is of great significance to the development and prognosis of patients. The clinical evaluation of cerebral vascular narrow narrow common inspection methods have digital subtraction angiography imaging (digital subtraction angiography, DSA (transcranial Doppler), transcranial Doppler, TCD CT angiography (CT), angiography, CTA) and magnetic resonance angiography (magneticresonance angiography MRA), but these tests have shortcomings of one kind or another. High resolution magnetic resonance imaging (high-resolution, MRI, HRMRI) angiography is new, not only can the lumen of imaging, but also can directly show the wall structure, has been maturely applied in extracranial carotid arteries can accurately assess carotid artery stenosis Degree. In recent years, with the rapid development of high field MRI scanners, HRMRI has been serving the large intracranial arteries. The middle cerebral artery (middle cerebral, artery, MCA) is a direct continuation of the internal carotid artery in intracranial atherosclerosis and other diseases, is the most easy to invade and blood vessels, according to the report, MCA atherosclerotic stenosis is the most common cause of ischemic cerebrovascular disease. So, how to HRMRI in assessing the effectiveness of large intracranial artery stenosis? In addition, the daily work, clinicians often encountered similar problems, namely, the severity of the preponderant part of patients with vascular stenosis, cerebral infarction, and the other part of patients showed only TIA how to explain this phenomenon, what? The degree of stenosis of the vessel in patients with cerebral infarction and TIA patients had no difference?
In view of the above questions, this study includes two aspects. It aims to explore the diagnostic value of HRMRI for stenosis or occlusion of middle cerebral artery (MCA) and the difference between MCA stenosis and cerebral infarction and TIA caused by atherosclerotic stenosis.
objective
To investigate the value of HRMRI diagnosis of middle cerebral artery stenosis or occlusion. Methods: collected from October 2012 -2013 year in October in our hospital treated 55 cases of interventional radiology by MRA or CTA confirmed MCA M1 segment stenosis caused by transient ischemic attack or cerebral infarction patients, 33 cases were male, 22 were female, age 17-68 years old. An average of 44.8 years. All patients underwent MRA, HRMRI and DSA, the mean time between 3.4 days. With DSA as the gold standard, combined with analysis of MRA HRMRI in diagnosis of artery stenosis in different degrees in the brain.
Result
55渚嬫偅鑰呮湁55鏀�澶ц剳涓�鍔ㄨ剦(MCA)鍦∕RA,HRMRI鍜孌SA涓婂潎鍙戠幇绠¤厰鐙�绐�.鍏朵腑鏈

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