本文關(guān)鍵詞：高分辨磁共振成像與超聲檢查對頸動脈粥樣硬化斑塊的診斷價值　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:探討高分辨磁共振成像與超聲檢查對頸動脈粥樣硬化斑塊的診斷價值。方法:篩選經(jīng)超聲顯示為頸動脈狹窄的患者40例(男性23例,女性17例)平均年齡(65士10)歲,其中年齡70歲1例;頸內(nèi)動脈、頸外動脈、頸總動脈共240支血管行頸動脈分叉部行高分辮頸動脈斑塊MRI多序列掃描,探究頸動脈硬化斑塊組成、斑塊類型、管腔狹窄;比較高分辨磁共振與頸部超聲檢查對頸動脈斑塊形態(tài)、組成、易損性及血管腔狹窄程度等方面的敏感性、準確性。排除標準:研究對象若滿足以下其中一條時,則不能入選該研究:1.患有嚴重心功能不全或心衰,急性冠狀血管供血不足及不穩(wěn)定型心絞痛等,心肌梗死,控制不佳的心律失常(房顫);2.肝臟、腎臟功能不全(血清肌酐178μmol/L,GFR29ml/min;肝轉(zhuǎn)氨酶2倍正常值上限);3.既往有腦出血病史;4.既往有抽搐、癲癇及肌病史;5.體內(nèi)裝有不適合進行磁共振檢查的金屬異物或起搏器等;既往有精神障礙及幽閉恐懼患者。結(jié)果:1.高分辨磁共振血管壁成像能清晰顯示動脈硬化斑塊組成、性質(zhì),經(jīng)對符合研究要求患者HR-MRI圖像進行詳細分析顯示主要表現(xiàn)為頸動脈管壁環(huán)形或偏心性管壁增厚、及斑塊內(nèi)部多種不同信號等影像學(xué)改變,頸動脈環(huán)形或偏心性管壁增厚等形態(tài)學(xué)改變與頸動脈超聲檢查相近,因病變內(nèi)部成分混雜多樣,超聲表現(xiàn)為斑塊回聲均質(zhì)和不均質(zhì)改變,MRI信號表現(xiàn)差異較大,不同信號特征所反映不同病理組成成分,斑塊內(nèi)部新近出血在呈不規(guī)則高信號,纖維帽完整時在3D-TOF上顯示為線樣低信號帶,在余序列上呈等或較高改變,發(fā)生破潰時,可表現(xiàn)為低信號帶中斷或缺乏,脂質(zhì)在3D-TOF像上呈等信號,質(zhì)子、T1加權(quán)上多呈等低信號,T2加權(quán)呈稍低信號改變。2.HR-MRI與頸動脈超聲檢查對斑塊性質(zhì)及動脈管腔狹窄程度的比較2.1 HR-MRI和頸動脈超聲檢查判別血管狹窄水平分級:HR-MRI掃描判別血管狹窄水平輕度、輕中度、重度、完全閉塞分別為12根、42根、16根、4根;頸動脈超聲檢查判別血管狹窄水平輕度、輕中度、重度、完全閉塞分別為13根、40根、17根、4根。評估管腔狹窄程度方面兩種影像學(xué)檢查手段相比,c2=0.008,P0.05,差異無統(tǒng)計學(xué)意義(P0.0 5)。2.2頸動脈二維超聲檢查顯示,動脈粥樣硬化斑塊分為規(guī)則型(回聲均質(zhì))、不規(guī)則型和潰瘍型(回聲不均),其中規(guī)則型(回聲均質(zhì))近似于磁共振II和III型,而不規(guī)則型和潰瘍型(回聲不均)斑塊近似于磁共振IV-VI型,HR-MRI檢出頸動脈易損斑塊38處,其中頸動脈超聲檢出26處,c2=4.00,P0.05,差異有統(tǒng)計學(xué)意義(P0.05)見表5,后經(jīng)HR-MRI證實12處可疑病變?yōu)橐讚p斑塊,對易損斑塊檢出HR-MRI較超聲敏感。3.各型斑塊的分布:40例HR-MRI圖像質(zhì)量均符合本次研究的標準要求,顯示動脈粥樣硬化斑塊共74處,其中I-II型、III型、IV-V型、VI型、VII-VIII型分別為12.1%,23.0%,21.6%,29.7%,13.5%。頸動脈3個不同部位各型斑塊的分布見表3。統(tǒng)計結(jié)果顯示頸動脈3個部位易損斑塊與穩(wěn)定斑塊在的分布c2=11.25,P0.05,差異無統(tǒng)計學(xué)意義(c2檢驗,P0.05)見表4。結(jié)論:1.高分辨MRI能清晰顯示頸動脈粥樣硬化斑塊組成成分、管腔狹窄水平,判斷斑塊易損性。2.高分辨MRI對頸動脈粥樣硬化斑塊性質(zhì)方面較超聲檢查具有明顯優(yōu)越性。
[Abstract]:Objective: To explore the value of high resolution magnetic resonance imaging and ultrasonography in diagnosis of carotid atherosclerosis. Methods: screening ultrasound showed 40 cases of carotid artery stenosis patients (23 males, 17 females) with an average age of (65 + 10) years old, the age of 70 in 1 cases; internal carotid artery, external carotid artery the common carotid artery, 240 vessels for carotid bifurcation for high-resolution carotid plaque MRI sequence scanning, explore the carotid plaque, plaque type, luminal stenosis; comparison of high resolution magnetic resonance imaging and neck ultrasonography on carotid plaque morphology, sensitivity, vulnerability and vascular stenosis degree the accuracy of the research object. Exclusion criteria: if it satisfies the following one, is not included in the study: 1. patients with serious cardiac dysfunction or heart failure, acute coronary vascular insufficiency and unstable angina, myocardial infarction, control Poor arrhythmia (atrial fibrillation); 2. liver and kidney dysfunction (serum creatinine 178 mol/L, GFR29ml/min; liver transaminase is 2 times the upper limit of normal); 3. patients with cerebral hemorrhage; 4. patients with convulsions, epilepsy and myopathy history; 5. are installed in the body is not suitable for magnetic resonance examination of metallic foreign body or had a pacemaker; mental disorders and claustrophobic patients. Results: 1. high resolution magnetic resonance imaging can clearly display the vascular wall plaque composition, properties, to meet the requirements of HR-MRI patients by image analysis showed in detail mainly for the carotid artery wall or eccentric annular wall thickness changes and plaque a variety of different signal imaging, carotid artery wall thickening or eccentric annular morphological changes and carotid artery ultrasonography is similar, because the lesion internal components of hybrid diversity, ultrasound showed homogeneous and heterogeneous changes in plaque echo MRI, the difference signal is large, different signal characteristics reflect different pathological components, internal hemorrhage in recent plaques showed irregular high signal integrity of the fibrous cap when displayed on the 3D-TOF line with low signal, a change in the sequence or higher than that burst, showed low signal interrupt or lack of lipid were isointense on 3D-TOF like proton weighted multi T1 showed low signal, T2 weighted.2.HR-MRI showed slightly low signal change and examination of carotid artery ultrasound for degree of plaque and artery stenosis is 2.1 HR-MRI and carotid ultrasound classification of vascular stenosis level: HR-MRI scanning and discrimination vessels the level of mild stenosis, mild to moderate and severe occlusion, respectively 12, 42, 16, 4; ultrasound examination of carotid stenosis level distinguish mild, mild to moderate and severe occlusion, respectively 13, 40, 17, 4. Assessment of stenosis of two kinds of imaging methods compared to c2=0.008, P0.05, the difference was not statistically significant (P0.0 5).2.2 carotid ultrasound examination showed that atherosclerotic plaques were divided into regular (homogeneous echo), irregular type and ulcerative type (uneven echo), which rules (homogeneous echo approximation) in magnetic resonance II and III type, irregular type and ulcerative type (uneven echo) plaques similar to magnetic resonance IV-VI, HR-MRI detection of carotid artery plaque 38, carotid artery ultrasound detected 26, c2=4.00, P0.05, and there was statistically significant difference (P0.05) see Table 5, after HR-MRI confirmed 12 suspicious lesions of vulnerable plaque, the plaque detection distribution of HR-MRI ultrasonic sensitive.3. various types of plaque in 40 cases of HR-MRI image quality can meet the requirements of the standard, display a total of 74 atherosclerotic plaque, including type I-II, type III, type IV-V, VI Type, type VII-VIII were 12.1%, 23%, 21.6%, 29.7%, the distribution of 13.5%. of carotid artery in 3 different parts of various types of plaques in table 3. statistical results show that the distribution of carotid artery c2=11.25, 3 parts of vulnerable plaques and stable plaques in P0.05, there was no statistically significant difference (C2 test, P0.05) conclusion: see table 4. 1. high resolution MRI can clearly display the carotid atherosclerotic plaque composition, stenosis level, judge MRI on the properties of carotid atherosclerotic plaque with ultrasound has obvious advantages of high resolution.2. plaque vulnerability.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445;R543.4

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