椎基底动脉延长扩张症的影像解剖学基础及诊断方法的对比研究

发布时间：2018-05-20 11:28

本文选题：椎基底动脉延长扩张症 + 磁共振血管造影　；参考：《河北医科大学》2014年硕士论文

【摘要】：背景：椎基底动脉延长扩张症(vertebrobasilar dolichoectasia, VBD)是一种少见的原因不明的后循环血管结构异常性疾病,以椎基底动脉显著延长、扩张、扭曲或成角为主要表现,Morgagni1761年首次报道。随着VBD病例的不断报道,对其病因、发病机制及病理研究的不断深入,发现VBD可能是由动脉壁缺陷、高血压及动脉粥样硬化等多重因素的共同作用所致。多数VBD患者临床症状不明显,且无特异性临床表现,临床症状复杂多样,后循环缺血是其最常见的临床表现。随访发现,椎基底动脉延长扩张症具有较高的死亡率及致残率,且并无有效的预防手段。近年来,显微神经外科和神经影像学,尤其是高分辨率MRI、MRA、CTA、DSA等血管结构影像技术的发展,推动了VBD的病因学、影像学诊断及治疗的相关研究。MRA的应用大大提高了VBD的诊断率,关于VBD的报道逐渐增多,高分辨率MRI结合MRA可显示椎动脉的结构及其与毗邻组织的结构关系,为VBD的诊断提供了客观的临床依据。目的：对比MRA+MRI和CTA两种检测方法对VBD的诊断价值。方法：随机选取40例经Smoker头颅CT诊断标准诊断为VBD的患者,分为两组,其中20例患者采用MRA联合MRI平扫,20例患者采用CTA。总结两组患者的VBD影像学形态特征数据(包括：单侧椎动脉纤细、瘤样扩张、均匀性增粗、血管壁钙化、血管壁的粥样硬化斑块、脑干受压、面神经或三叉神经受压等),并进行对比分析；总结两组患者的VBD临床表现分型数据,并进行对比分析,同时对两组患者的影像学临床症状表现进行对比。结果：VBD主要靠CTA薄层扫描平扫来进行诊断,颅底、蝶鞍及鞍上池层面显示后颅窝,伪影较重,基底动脉周围有低信号的脑脊液做对比,基底动脉迂曲增宽可通过CTA 2D图像显示横切或斜切增粗的血管结构异常,也可直接显示血管壁的钙化,所以CTA可以作为筛查VBD的影像学检查方法。MRI常规序列扫描,由于血管流空效应,水平位(轴位)图像上椎基底动脉显示为明显的黑色低信号,也可显示管壁变薄、增厚血管壁的粥样硬化程度及脑干颅神经压迫等情况,可通过血管及毗邻组织结构学异常解释临床症状,为VBD的诊断提供参考依据。MRA可清晰地显示椎基底动脉结构,在显示椎基底动脉结构形态上不亚于CTA及DSA,且MRA属于无创检查,无X线辐射,无需注射造影剂,无需担心放射及造影剂副反应的影响。MRA可结合MRI平扫图像显示迂曲延长的椎基底动脉压迫毗邻脑组织的情况,显示压迫位置、程度,推断阻塞性脑脊液循环障碍或缺血性脑血管事件的原因,并可显示是否合并其他脑血管疾病,如血管狭窄、血栓形成及动脉瘤等。结论：两组患者在显示钙化及对颅神经压迫方面存在差异,但在显示VBD其他影像学形态特征上无明显差异；两组患者的VBD临床表现分型数据无明显差异,且两种影像学检测方法都可以很好地反映VBD患者的临床症状表现。因此,在VBD影像学诊断中,MRI+MRA与CTA具有相似的特异性和敏感性。
[Abstract]:Background: vertebrobasilar dolichoectasia (VBD) is a rare and unexplained posterior circulatory vascular disorder. It is the main manifestation of vertebral basilar artery prolonged, dilatation, distortion or angle formation. It was first reported in Morgagni1761. With the continuous reporting of VBD cases, the etiology and pathogenesis of the vertebral basilar artery were reported. It is found that VBD may be the result of multiple factors such as arterial wall defects, hypertension and atherosclerosis. Most of the patients with VBD have not obvious clinical symptoms, and there are no specific clinical manifestations and complex clinical symptoms. Posterior circulation ischemia is the most common clinical manifestation. Follow up findings, vertebrobasilar artery (vertebrobasilar artery) Prolonged dilatation has a high mortality and disability rate, and there is no effective means of prevention. In recent years, the development of microscopic Department of neurosurgery and neuroimaging, especially high resolution MRI, MRA, CTA, DSA, has promoted the etiology, imaging diagnosis and treatment of VBD, and the application of.MRA has greatly improved the VBD The rate of diagnosis of VBD is increasing. High resolution MRI combined with MRA can show the structure of vertebral artery and its relationship with adjacent tissue, which provides an objective clinical basis for the diagnosis of VBD. Objective: To compare the diagnostic value of two detection methods of MRA+MRI and CTA to VBD. Square method: randomly selected 40 cases of Smoker head CT diagnosis. The patients who were diagnosed with VBD were divided into two groups, of which 20 patients were treated with MRA combined with MRI scan, and 20 patients used CTA. to sum up the morphological features of VBD imaging in two groups (including: unilateral vertebral artery slender, tumor like dilation, uniformity thickening, vascular wall calcification, atherosclerotic plaque in the vascular wall, brain stem compression, facial nerve, or trigeminal nerve. The VBD clinical manifestation data of the two groups of patients were analyzed and compared, and the clinical symptoms of the two groups were compared. Results: the diagnosis of the VBD was mainly by CTA thin scan, the skull base, the sella and the suprasellar pool showed the posterior cranial fossa, the artifacts were heavier and the basement moved. A contrast of low signal cerebrospinal fluid around the vein, the basilar artery circuitous widening can show transverse or thickening vascular abnormalities through the CTA 2D image, and can also direct the calcification of the vascular wall, so CTA can be used as an imaging examination for screening VBD,.MRI routine sequence scanning, the horizontal (axial) image due to the flow effect of blood vessels. The upper vertebral basilar artery is shown as a clear black low signal. It can also show the thinning of the wall of the tube, the degree of atherosclerosis and the oppression of the cranial cranial nerve in the thickened vascular wall. It can explain the clinical symptoms through the abnormalities of blood vessels and adjacent tissue structures, and provide a reference basis for the diagnosis of VBD with.MRA clearly showing the structure of the vertebral basilar artery. The structure of vertebrobasilar artery is no less than CTA and DSA, and MRA is noninvasive, no X-ray, no injection of contrast agent, no need to worry about the effect of radiation and side effects of contrast agent,.MRA can combine MRI plain scan to display the compression of the vertebral basilar artery adjacent to the brain tissue, showing the position of compression, degree, and inferring the obstructive brain. The causes of spinal fluid circulation disorder or ischemic cerebrovascular events can show whether the combination of other cerebrovascular diseases, such as vascular stenosis, thrombosis and aneurysm, etc. conclusion: there are differences in calcification and cranial nerve compression in the two groups, but there are no significant differences in the morphological features of the other images of the VBD; the two groups of patients There is no significant difference in the clinical manifestation data of VBD, and the two imaging methods can reflect the clinical symptoms of VBD patients well. Therefore, in the diagnosis of VBD imaging, MRI+MRA and CTA have similar specificity and sensitivity.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R322.8;R743

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