高分辨磁共振成像在颅内未破裂动脉瘤中的应用研究

发布时间：2018-07-05 18:04

  本文选题：颅内动脉瘤 + 磁共振血管成像　； 参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：研究背景：磁共振血管成像是颅内未破裂动脉瘤筛查的重要技术之一,它具有无创、无辐射、无需静脉给药等优点,受到临床亲睐。但既往磁共振场强较低,成像质量不高,磁共振血管成像的敏感度无法和数字减影血管造影术及CT血管成像术相比。近年来,3T磁共振的临床应用及新的血管成像技术的发展,使得磁共振在颅内未破裂动脉瘤的形态和破裂风险的评估中发挥越来越重要的作用。目的：1.以DSA成像作为参照,在3TMRA上测量动脉瘤的瘤颈、瘤体横径及顶径距这三个形态学指标,评估两者之间的差异;2.在高分辨磁共振上判断瘤壁的薄弱部位、瘤壁增强显影情况、并探索磁共振影像与术中所见的相关性。方法：第一部分 16例颅内未破裂动脉瘤患者行DSA和MRA检查,分别在DSA和MRA上测量瘤颈、瘤体横径及顶径距这三个参数。将三个参数分别进行统计分析,判断两种检查是否存在统计学差异。第二部分 16例患者均行高分辨血管壁成像(MSDE序列)及增强(CE MSDE)扫描,在MSDE序列上根据瘤壁显影情况分级：瘤壁显影≥60%为Ⅰ级。30%-60%瘤壁显影为Ⅱ级,≤30%瘤壁显影为Ⅲ级：对比MSDE和CE MSDE上瘤壁显影情况分为“明显强化”、“一般强化”和“无强化”三组：16例患者中有12例行开颅手术,根据术前磁共振上对瘤壁厚度判断情况与术中所见对比,结果分为三类：与预期一致,与预期相符,与预期不同。结果：第一部分 瘤颈平均值：DSA为9.29±4.04mm, MRA为8.93±4.72mm,差异无统计学意义(Z=-1.19,P=0.2340.05,r=0.968)；瘤体横径平均值：DSA为12.65±6.86mm, MRA为12.91±6.83mm,两者差异无统计学意义(Z=-0.88,P=0.3790.05,r=0.933);顶颈距平均值：DSA为14.23±0.95mm, MRA为13.86±0.96mm,两者差异无统计学意义(Z=-1.48,P=0.140.05,r=0.499)。第二部分MSDE序列上2例瘤壁1级显影,8例瘤壁2级显影,6例瘤壁3级显影；CE MSDE上瘤壁1级显影12例,2级显影3例,3级显影1例;在CE MSDE序列上2例瘤壁明显强化,11例一般强化,3例无强化;在12例开颅手术病例中,7例术中所见与预期一致,3例与预期相符,2例与预期不符。结论：3T磁共振上MRA是评估动脉瘤形态的有效检查;动脉瘤的高分辨MSDE和CE MSDE图像能提供动脉瘤壁的重要信息,有助于未破裂动脉瘤的手术策略制定和动脉瘤破裂风险的评估。
[Abstract]:Background: magnetic resonance angiography (MRA) is one of the important techniques for the screening of intracranial unruptured aneurysms. It has the advantages of non-invasive, non-radiation and no intravenous administration. However, the sensitivity of Mr angiography can not be compared with that of digital subtraction angiography and CT angiography. In recent years, the clinical application of 3T magnetic resonance imaging and the development of new angiography technology make MRI play an increasingly important role in the evaluation of the morphology and risk of rupture of intracranial unruptured aneurysms. Purpose 1. The aneurysm neck, transverse diameter and parietal diameter of the aneurysm were measured on 3T MRA with DSA imaging as the reference, and the difference between them was evaluated. The weak position of the tumor wall and the enhancement of the tumor wall were determined on high resolution MRI, and the correlation between MRI and intraoperative findings was explored. Methods: in the first part, DSA and MRA were performed in 16 patients with unruptured intracranial aneurysms. The tumor neck, transverse diameter and parietal diameter were measured on DSA and MRA respectively. The three parameters were statistically analyzed to determine whether there were statistical differences between the two tests. In the second part, all 16 patients underwent high-resolution angiography (MSDE) and enhanced angiography (CE MSDE). According to the development of the tumor wall on the MSDE sequence, the tumor wall development 鈮，

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