基于CTA或MRA研究颈内动脉狭窄和再通与MRI颅内高信号血管征的相关性

发布时间：2018-11-21 14:03

【摘要】：目的： 1.探讨MRI颅内高信号血管征(hyperintense vessel sign, HVS)与颈内动脉(internal carotid artery, ICA)狭窄程度的相关性,揭示HVS的形成机制及临床意义。 2.观察颈动脉内膜剥脱术(carotid endarterectomy, CEA)前后HVS的变化,探讨HVS对CEA的价值。方法：回顾性分析1221例行颈动脉血管成像及头颅MRI液体衰减翻转恢复(fluid-attenuated inversion recovery, FLAIR)序列检查患者的影像学资料,并对83例行CEA的ICA狭窄患者术前术后影像学资料进行对照分析。病例资料的纳入标准：(1)患者有完整的头颈部CTA或头颈部MRA资料,以及头颅MRI(含FLAIR序列)资料；(2)头颈部CTA或MRA图像显示双侧大脑中动脉(Middle cerebral artery, MCA)无狭窄；(3)CEA术后复查头颈部CTA及头颅MRI均在术后3天内完成。根据有无ICA狭窄,将患者资料分为ICA狭窄组及ICA无狭窄组,ICA狭窄组进一步分为单侧ICA狭窄组及双侧ICA狭窄组。采用χ2检验分析ICA狭窄组与ICA无狭窄组、单侧ICA狭窄组与双侧ICA狭窄组之间HVS的发生率的差异。根据有无Willis、环侧支血流,将单侧ICA狭窄组中狭窄程度70%的病例分为有Willis环侧支血流组和无Willis环侧支血流组,采用χ2检验分析两组之间HVS发生率的差异。在单侧ICA狭窄组中,根据ICA狭窄程度分为七个等级,即50%、50%～59%、60%～69%、70%～79%、80%～89%、90%～99%、100%,采用Spearman等级相关分析HVS阳性率与ICA程度之间的相关性。对照分析83例CEA手术前后FLAIR图像,观察HVS的变化。结果： 1.ICA狭窄组HVS阳性率41.12%(125/304),ICA无狭窄组HVS阳性率11.78%(108/917),ICA狭窄组HVS的阳性率显著高于ICA无狭窄组(χ2=127.289,P0.001)。 2.单侧ICA狭窄组HVS阳性率39.3%(90/229),双侧ICA狭窄组HVS阳性率48%(36/75),两组之间HVS阳性率无统计学意义(χ2=1.762,P0.05)。 3.单侧ICA狭窄组ICA狭窄程度各等级的HVS阳性率依次为15.38%、12.9%、38.46%、33.33%、41.67%、67.86%、85.71%,HVS阳性率与ICA狭窄程度呈显著正相关关系(r=0.929,P0.001)。 4.单侧ICA狭窄组中ICA狭窄程度70%的病例94例,有Willis环侧枝血流组HVS阳性率56.25%(36/64)；无Willis环侧枝血流组HVS阳性率93.33%(28/30)。无Willis环侧枝血流组HVS的阳性率显著高于有Willis环侧枝血流组(χ2=12.927,P0.001) 5.CEA术前40例HVS阳性,术后31例HVS消失,HVS仍然存在的9例与CEA手术部位远端的血管狭窄相关。结论： 1.MRI颅内FLAIR序列出现HVS提示ICA可能存在严重狭窄,进一步针对ICA的评估是非常必要的。 2.CEA术后HVS消失,可成为评估CEA手术效果的有效指标之一。
[Abstract]:Objective: 1. To investigate the correlation between intracranial hyperintense vascular sign (hyperintense vessel sign, HVS) and stenosis of internal carotid artery (internal carotid artery, ICA) in MRI, and to reveal the mechanism and clinical significance of HVS. 2. To observe the changes of HVS before and after carotid endarterectomy before and after (carotid endarterectomy, CEA), and to explore the value of HVS in CEA. Methods: the imaging data of 1221 patients with carotid angiography and MRI fluid attenuated inversion (fluid-attenuated inversion recovery, FLAIR) were retrospectively analyzed. The imaging data of 83 CEA patients with ICA stenosis before and after operation were analyzed. The inclusion criteria of case data were as follows: (1) complete CTA or MRA data of head and neck, and MRI (including FLAIR sequence) of head and neck, (2) CTA or MRA images of head and neck showed no (Middle cerebral artery, MCA) stenosis in bilateral middle cerebral artery (MCA). (3) CTA and MRI of head and neck were completed within 3 days after CEA. According to ICA stenosis, the patients were divided into ICA stenosis group and ICA without stenosis group. ICA stenosis group was further divided into unilateral ICA stenosis group and bilateral ICA stenosis group. The incidence of HVS in ICA stenosis group and ICA without stenosis group, unilateral ICA stenosis group and bilateral ICA stenosis group were analyzed by 蠂 2 test. According to the Willis, annular collateral blood flow, 70% of the patients with unilateral ICA stenosis were divided into Willis ring collateral blood flow group and no Willis ring collateral blood flow group. The difference of HVS incidence between the two groups was analyzed by 蠂 2 test. In the unilateral ICA stenosis group, according to the degree of ICA stenosis, they are divided into seven levels, namely, 50 and 50. Spearman grade correlation was used to analyze the correlation between HVS positive rate and ICA degree. FLAIR images of 83 cases with CEA before and after operation were analyzed and the changes of HVS were observed. Results: the positive rate of HVS in patients with 1.ICA stenosis was 41.12% (125 / 304), ICA) and the positive rate of HVS was 11.78% (108 / 917), ICA stenosis), which was significantly higher than that in ICA without stenosis (蠂 2 / 127.289 P 0.001). 2. The positive rate of HVS in unilateral ICA stenosis group was 39.3% (90 / 229), and that in bilateral ICA stenosis group was 48% (36 / 75). There was no significant difference in HVS positive rate between the two groups (蠂 2, 1.762P 0.05). 3. In the unilateral ICA stenosis group, the positive rate of HVS in each grade of ICA stenosis was 15.38 and 12.9, and the positive rate was 38.463.33 and 41.676.86 and 85.71, respectively. The positive rate of HVS was positively correlated with the degree of ICA stenosis (r = 0.929, P 0.001). 4. In the unilateral ICA stenosis group, the positive rate of HVS was 56.25% (36 / 64) in the ICA stenosis group and 93.33% (28 / 30) in the non-Willis loop collateral blood flow group, and the positive rate of HVS was 56.25% (36 / 64) in the ICA stenosis group and 93.33% (28 / 30) in the non-Willis loop collateral flow group. The positive rate of HVS in the blood flow group without Willis ring was significantly higher than that in the Willis ring collateral blood flow group (蠂 2 + 12.927% P0.001). The positive rate of HVS was found in 40 cases before and after the operation of 5.CEA, and the HVS disappeared in 31 cases after operation. The presence of HVS in 9 cases was related to the stenosis of the distal end of CEA. Conclusion: the presence of HVS on intracranial FLAIR sequence in 1.MRI suggests that ICA may have severe stenosis, and it is necessary to evaluate ICA further. The disappearance of HVS after 2.CEA may be one of the effective indexes to evaluate the effect of CEA.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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