致缺血性卒中颅内动脉夹层的MRI评估价值

发布时间：2019-01-14 07:23

【摘要】：目的探讨常规MRI、MR血管成像(MRA)和高分辨MRI诊断致缺血性卒中的颅内动脉夹层(IAD)的价值。方法前瞻性连续纳入59例于2008年8月至2015年4月在中山大学附属第一医院神经科住院的IAD致缺血性卒中患者[年龄(45±15)岁,男41例]。所有患者接受常规头部MRI/MRA检查,对其中25例行全脑DSA检查,对10例行高分辨MRI。分析IAD的常规MRI/MRA和高分辨MRI表现。对行DSA的患者,比较DSA与常规MRI/MRA对典型夹层征象的检出及符合率。结果 (1)59例中,常规MRI/MRA检测到42例(71.2%)典型夹层征象,其中以壁内血肿(52.4%,22例)最常见,其他征象包括内膜征/双腔征(31.0%,13例)和长段不规则或丝线样狭窄(21.4%,9例);而夹层动脉瘤(16.7%,7例)和鼠尾状闭塞(7.1%,3例)相对少见;常规MRI/MRA未检测到典型夹层征象的17例(28.8%)IAD中,夹层累及大脑中动脉(64.7%,11/17)较常规MRI/MRA检测到典型夹层征象的42例IAD(23.8%,10/42)更为多见,差异有统计学意义(χ2=11.325,P=0.006)。(2)25例接受DSA检查的患者中,15例(60.0%)有典型夹层征象;而常规MRI/MRA仅检测到其中8例(32.0%)有典型夹层征象,但差异无统计学意义(P=0.088)。(3)有10例(16.9%)IAD常规MRI/MRA和DSA均显示非特异性局限性狭窄或截断样闭塞,而高分辨MRI检测到其中5例有内膜征,4例有壁内血肿,1例有内膜征和壁内血肿。结论常规头部MRI/MRA是检测IAD的有效技术,而高分辨MRI在诊断其他血管影像学检查无典型夹层表现的IAD方面独具优势。
[Abstract]:Objective to evaluate the value of conventional MRI,MR angiography (MRA) and high resolution MRI in the diagnosis of intracranial artery dissection (IAD) in ischemic stroke. Methods 59 consecutive patients with ischemic stroke caused by IAD from August 2008 to April 2015 were enrolled in the Department of Neurology, first affiliated Hospital of Sun Yat-sen University [age: (45 卤15) years, male: 41 cases]. All patients underwent routine head MRI/MRA examination, 25 of them underwent whole brain DSA, and 10 underwent high resolution MRI.. The conventional MRI/MRA and high resolution MRI findings of IAD were analyzed. To compare the detection and coincidence rate between DSA and conventional MRI/MRA for typical dissection signs in patients with DSA. Results (1) among the 59 cases, 42 cases (71.2%) were detected typical dissection signs by routine MRI/MRA. The most common sign was intramural hematoma (52.442%), and other signs included intimal sign / double lumen sign (31.0%). 13 cases and 9 cases with long segment irregular or filamentous stenosis (21. 4%); Dissecting aneurysms (16.7 cases) and rat caudate occlusion (7.1 cases) were relatively rare. In 17 cases (28.8%) of IAD without typical dissection signs detected by conventional MRI/MRA, dissection involving middle cerebral artery (64.7 / 17) was higher than that of 42 cases (23.8%) with typical dissection sign detected by conventional MRI/MRA. (10 / 42) the difference was statistically significant (蠂 ~ 2 = 11.325). (~ (0.006). (~ (2). Of the 25 patients undergoing DSA examination, 15 (60.0%) had typical dissection signs. However, only 8 cases (32.0%) were found to have typical dissection signs by conventional MRI/MRA. However, there was no significant difference (P0. 088). (3) in 10 cases (16. 9%) of IAD, both conventional MRI/MRA and DSA showed nonspecific localized stenosis or truncated occlusion, and 5 cases had intimal signs detected by high resolution MRI. 4 cases had intramural hematoma, 1 case had intimal sign and intramural hematoma. Conclusion conventional head MRI/MRA is an effective technique for detection of IAD, while high resolution MRI has a unique advantage in the diagnosis of IAD with no typical dissection in other vascular imaging examinations.
【作者单位】：中山大学附属第一医院放射科;中山大学附属第一医院神经内科;
【基金】：广东省医学科研基金项目(B2012083)
【分类号】：R743.3;R445.2

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