多模式核磁共振成像技术在脑动脉夹层早期诊断中的价值

发布时间：2018-02-25 18:50

本文关键词： 核磁共振脑动脉夹层早期诊断　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:探讨脑动脉夹层(cerebral artery dissection CAD)的特点及多模式核磁共振技术在CAD早期诊断中的应用价值。研究方法:收集2014-1到2016-12青岛大学医学院附属医院神经科收治的脑动脉夹层患者46例,均经颅脑及颈部核磁共振检查并经全脑血管DSA检查确诊。以DSA检查作为“金标准”,对比DSA检查,分析核磁共振对颈内动脉及椎-基底动脉夹层诊断的优势及敏感性,所得数据均采用SPSS19.0统计软件进行分析处理、比较,差异显著性采用X2检验。研究结果:1.MRI在常规颈部横断位T1加权和T2加权像上,夹层表现为动脉壁的新月形高信号,T2加权成像在夹层分离导致的内膜瓣比X线数字减影(DSA)准确性好。2.MRA即磁共振血管成像,表现为血管闭塞动脉、动脉瘤样扩张、线珠征或者假性动脉瘤等多种不同征象。3.3D-HR-MRI即高分辨核磁成像,对血管壁周围结构及血管壁的辨别性更好,能更准确地发现管腔偏心狭窄、管壁内血肿或闭塞,或血栓或内膜片等影像学特征性征象。如果我们怀疑患者可能患有颅内外血管夹层,应首先行头颈部的MRA/MRI、头颅MRI,可提供梗死的部位以及供血血管的截面,在轴位压脂相上可以见到血管壁内血肿,依据CAD的发生病理机制不同,表现为不同的影像学特点,所以对壁内血肿的鉴别分析是诊断脑动脉夹层的关键点之一。一旦表现出壁内血肿的特征,就明确支持脑动脉夹层的诊断;当斑块形态类似于夹层血肿范围时,夹层血肿与斑块内出血可用DWI来协助诊断,并且为准时正确治疗提供重要的信息。头颈部磁共振血管成像亦可显示血管扩张或狭窄或者闭塞情况;并且可以作为随诊、筛查以及动态监测的较好方法;研究结论:在本研究中,多模式核磁共振检查技术无创、依从性好,对CAD早期诊断的敏感性及特异性较理想,联合DSA相互补充,提高了早期确诊率及治愈率,正因为壁内血肿是脑动脉夹层的特征性表现之一,多模式核磁共振成像具有准确判断壁内血肿的特点,若核磁无法明确诊断需进一步明确诊断或需介入治疗,可进一步行DSA检查,所以推荐作为早期诊断CAD患者的首选检查方法。
[Abstract]:Objective: to investigate the characteristics of cerebral artery dissection CAD (cerebral artery dissection) and the value of multimode MRI in the early diagnosis of CAD. Methods: brain samples were collected from the Department of Neurology, affiliated Hospital of Qingdao University from 2014-1 to 2016-12. 46 patients with arterial dissection, All of them were diagnosed by MRI and DSA. The advantage and sensitivity of MRI in the diagnosis of internal carotid artery and vertebrobasilar artery dissection were analyzed by comparing DSA with DSA as "gold standard". The data were analyzed and processed by SPSS19.0 statistical software, and the difference was analyzed by X2 test. Results: 1. The results showed that: 1. MRI was performed on T 1 weighted and T 2 weighted images of the normal cervical transection. Crescent high-signal T 2-weighted imaging of dissected artery wall is more accurate than digital subtraction imaging (DSAA). 2. MRA, I. e., magnetic resonance angiography, shows artery occlusion and aneurysm dilatation. Linear bead sign or pseudoaneurysm. 3.3D-HR-MRI, or high-resolution nuclear magnetic resonance imaging, can distinguish the structure and wall of vascular wall better, and can more accurately detect the eccentric stenosis of the lumen, hematoma or occlusion in the wall. If we suspect that a patient may have a dissection of the intracranial or external vessels, we should first perform the head and neck MRI, the head MRI, to provide the location of the infarction and the section of the blood supply vessel. The intramural hematoma can be seen in the adipose phase of the axial position. According to the pathogenetic mechanism of CAD, there are different imaging features. Therefore, the differential analysis of intracerebral hematoma is one of the key points in the diagnosis of cerebral artery dissection. Once it shows the characteristics of intracerebral hematoma, it clearly supports the diagnosis of cerebral artery dissection; when the plaque shape is similar to the area of dissecting hematoma, Dissection hematoma and plaque hemorrhage can be diagnosed by DWI and provide important information for timely and correct treatment. MRI can also show vasodilation or stenosis or occlusion, and can be used as follow-up. Conclusion: in this study, multimode nuclear magnetic resonance (MRI) technique is noninvasive, good compliance, good sensitivity and specificity for early diagnosis of CAD, and combined with DSA to complement each other. The early diagnosis rate and cure rate were improved. Because intramural hematoma is one of the characteristic manifestations of cerebral artery dissection, multimode magnetic resonance imaging has the characteristics of accurately judging intramural hematoma. If the nuclear magnetic field can not make a definite diagnosis, it is necessary to make further diagnosis or interventional therapy, so it is recommended to be the first choice in the early diagnosis of CAD patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743;R445.2

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