3.0T HRMRI头颈联合技术对症状性MCA狭窄患者颅内外动脉管壁病变的诊断价值

发布时间：2018-04-24 16:00

本文选题：大脑中动脉 + 颈内动脉　；参考：《中风与神经疾病杂志》2017年05期

【摘要】：目的探讨症状性大脑中动脉(MCA)狭窄患者颅内外动脉管壁病变特点和3.0T高分辨磁共振成像(High-resolution magnetic resonance imaging,HRMRI)头颈联合技术的临床应用价值。方法 11例症状性MCA狭窄患者接受三维增强磁共振血管成像(3D ce-MRA)与3.0T HRMRI的T_1w-db SPACE平扫和T_1w-db SPACE增强扫描,并结合头颈部颅内外动脉管壁不间断联合扫描新技术。结果共扫描11例患者的88处颅内外动脉管壁,其结果发现:1例中枢神经系统血管炎,其左侧MCA及左侧颈内动脉(ICA)颅内段在T_1w-db SPACE像上表现为管壁环形增厚及环形强化;1例颅内动脉夹层,其左侧MCA在T_1w-db SPACE像呈长条状高信号,相应高信号在T_2wdb SPACE像上为等低信号;9例动脉粥样硬化患者均合并双侧MCA粥样硬化斑块,表现为管壁偏心性增厚,其中8例(88.9%)合并颅内外动脉粥样硬化,增强扫描见6例(67%)颅内外动脉粥样硬化斑块均有强化。比较3D ceMRA与HRMRI结果发现,88处血管中,23处血管的3D ce-MRA与HRMRI均未见明显异常;31处血管的3D ceMRA与HRMRI显示相对一致,即3D ce-MRA显示狭窄或者扩张、HRMRI显示管壁呈不同程度的增厚或附壁斑块;34处血管的3D ce-MRA与HRMRI显示欠一致,其中,26处血管的3D ce-MRA大致正常而HRMRI显示管壁增厚(5处)或斑块(21处),8处血管的3D ce-MRA显示轻度狭窄(6处)或扩张(2处)而HRMRI显示管腔外径及管壁均大致正常。判断颅内外动脉异常的组间一致性可(3D ce-MRA、HRMRI的Kappa值分别为0.67、0.69,P0.001)。结论 3.0T HRMRI头颈联合技术可清晰地显示颅内外动脉的管壁结构和病变特点,识别3D ce-MRA未能发现的狭窄,甄别动脉狭窄的病因,对颅内外动脉管壁病变的诊断具有较高的临床应用价值。
[Abstract]:Objective to investigate the characteristics of intracranial and external arterial wall lesions in patients with symptomatic middle cerebral artery stenosis and the clinical value of 3.0T high-resolution magnetic resonance imagingHRMRI technique. Methods 11 patients with symptomatic MCA stenosis underwent 3D enhanced magnetic resonance angiography (3D-ce-MRA), 3.0T HRMRI T_1w-db SPACE plain scan and T_1w-db SPACE enhanced scan. Results A total of 88 intracranial and external arterial walls were scanned in 11 patients, and 1 case of CNS vasculitis was found. On T_1w-db SPACE images, the left MCA and left internal carotid artery (ICA) segments were shown as annular thickening of the wall and circular enhancement of intracranial artery dissection. The left MCA showed long and high signal intensity on T_1w-db SPACE images. On T_2wdb SPACE images, 9 patients with atherosclerotic atherosclerosis were associated with bilateral MCA atherosclerotic plaques, with eccentric thickening of the wall, of which 8 patients were associated with atherosclerosis of the extracranial and intracranial arteries. Contrast-enhanced scans showed 6 cases of atherosclerotic plaques in the intracranial and external arteries. The results of 3D ceMRA and HRMRI showed that there was no obvious abnormality in 3D ce-MRA and HRMRI in 23 vessels in 88 vessels. The 3D ceMRA and HRMRI showed the same in 31 vessels. In other words, 3D ce-MRA showed stenosis or dilatation in different degree of thickening of the vessel wall or 3D ce-MRA of 34 vessels attached to the wall was not consistent with HRMRI. The 3D ce-MRA of 26 vessels was normal and HRMRI showed thickening of the wall in 5) or the 3D ce-MRA of 8 vessels in 21 lesions showed slight stenosis in 6 or dilated in 2) and HRMRI showed the diameter of the lumen and the wall of the vessel were normal. The Kappa values of 3D ce-MRA-HRMRI for the diagnosis of abnormal intracranial and external arteries were 0.670.69 and P 0.001, respectively. Conclusion 3.0T HRMRI combined with head and neck technique can clearly display the wall structure and pathological features of the external intracranial artery, identify the stenosis that can not be found by 3D ce-MRA, and identify the etiology of artery stenosis. It has a high clinical value in the diagnosis of intracranial and external arterial wall diseases.
【作者单位】：北京大学深圳医院神经内科;汕头大学医学院;中国科学院深圳先进技术研究院;
【基金】：深圳市战略新兴产业发展专项资金(No.JYCJ20150605103420338)
【分类号】：R445.2;R743.3

【相似文献】