本文選題：高分辨磁共振成像　切入點(diǎn)：磁共振血管成像　出處：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景 短暫性腦缺血發(fā)作（transient ischemic attack, TIA）和腦梗死均隸屬于缺血性腦血管病的范疇，發(fā)病率和致殘率高，早期檢出和治療對患者病情的發(fā)展及預(yù)后有著重要意義。臨床上常用的評估腦血管狹窄的檢查手段有數(shù)字減影血管成像（digital subtraction angiography, DSA）、經(jīng)顱多普勒超聲（transcranial Doppler,TCD）、CT血管成像（CT angiography, CTA）以及磁共振血管成像（magneticresonance angiography, MRA）,但這些檢查均存在這樣或那樣的不足。高分辨磁共振成像(high-resolution MRI，HRMRI)乃新興的血管成像技術(shù)，不僅可以進(jìn)行管腔成像，而且能夠直觀顯示管壁結(jié)構(gòu)，，目前已成熟應(yīng)用于顱外頸動脈，可以準(zhǔn)確評估頸動脈狹窄程度。近年來，隨著高場強(qiáng)磁共振掃描儀的快速研發(fā)，HRMRI已日漸服務(wù)于顱內(nèi)大動脈的研究。大腦中動脈（middle cerebral artery,MCA）為頸內(nèi)動脈在顱內(nèi)的直接延續(xù)，也是動脈粥樣硬化等疾病最易侵及的血管，據(jù)報道，MCA粥樣硬化性狹窄是國內(nèi)引起缺血性腦血管病最常見的原因。那么，HRMRI在評估顱內(nèi)大動脈狹窄方面的效力如何？另外，日常工作中，臨床醫(yī)生常遇到類似的問題，即嚴(yán)重程度匹敵的血管狹窄，部分患者出現(xiàn)了腦梗死，而另一部分患者則僅表現(xiàn)為TIA，該現(xiàn)象如何解釋？究竟責(zé)任血管的狹窄程度在腦梗死患者與TIA患者中有無差異？ 針對上述提出的問題，本研究囊括兩方面的內(nèi)容，旨在探討HRMRI對大腦中動脈(middle cerebral artery, MCA)狹窄或閉塞的診斷價值及MCA狹窄程度在動脈粥樣硬化性狹窄引起的腦梗死和TIA中的差異。 目的 探討HRMRI對大腦中動脈狹窄或閉塞的診斷價值。方法：搜集2012年10月-2013年10月我院介入科收治的55例經(jīng)MRA或CTA證實(shí)為MCA M1段不同程度狹窄導(dǎo)致的短暫性腦缺血發(fā)作或腦梗死患者,其中男33例，女22例，年齡17-68歲，平均44.8歲。所有患者均行MRA、HRMRI和DSA檢查,間隔時間平均3.4天。以DSA為金標(biāo)準(zhǔn)，結(jié)合MRA分析HRMRI對不同程度大腦中動脈狹窄的診斷價值。 結(jié)果 55例患者有55支大腦中動脈（MCA）在MRA、HRMRI和DSA上均發(fā)現(xiàn)管腔狹窄。其中有46支血管在HRMRI和DSA上測得的狹窄程度一致，符合率為83.6%（46/55）；MRA相較HRMRI診斷偏高率為61.8%(34/55)；HRMRI、DSA及MRA上測得的狹窄率分別為(70±17)%、(68±19)%、(85±20)%，HRMRI與DSA的狹窄率差異無統(tǒng)計學(xué)意義（Z=-1.192, P=0.233），與MRA的狹窄率差異有統(tǒng)計學(xué)意義（t=-6.604, P=0.000）。對HRMRI和DSA測得的MCA狹窄率進(jìn)行相關(guān)性分析，r=0.893（P=0.000，Pearson法）；對HRMRI和MRA測得的MCA狹窄率進(jìn)行相關(guān)性分析，r=0.602（P=0.000，Spearman法）。以DSA為金標(biāo)準(zhǔn)，HRMRI對大腦中動脈狹窄或閉塞診斷的Kappa值為0.773；以HRMRI為參考，MRA對大腦中動脈狹窄或閉塞診斷的Kappa值為0.355。 結(jié)論 HRMRI在評估大腦中動脈狹窄方面與DSA具有良好一致性，且能夠避免MRA高估血管狹窄程度的缺陷，較真實(shí)的反映腦動脈狹窄情況。 目的 應(yīng)用HRMRI研究責(zé)任血管為MCA的腦梗死和TIA患者M(jìn)CA狹窄程度的差異。 方法 收集2012年4月-2013年9月連續(xù)入組經(jīng)MRA或DSA證實(shí)的癥狀性MCAM1段動脈粥樣硬化性狹窄患者91例，使用3.0T磁共振掃描儀對狹窄段進(jìn)行HRMRI檢查，測量并計算血管狹窄率，并加掃DWI、T2WI及黑水序列明確有無腦梗死。 結(jié)果 78例患者納入最終分析，其中梗死患者46例，HRMRI上測得的狹窄率為0.72±0.21；TIA患者32例，HRMRI上測得的狹窄率為0.72±0.20，二者差異無統(tǒng)計學(xué)意義（t=-0.10, P=0.920.05）。 結(jié)論 責(zé)任血管為大腦中動脈的腦梗死與TIA患者，其大腦中動脈M1段狹窄程度無顯著性差異，提示血管狹窄程度并非動脈粥樣硬化性腦梗死發(fā)生的決定性因素。
[Abstract]:background
Transient ischemic attack (transient ischemic, attack, TIA) and cerebral infarction belongs to the category of ischemic cerebrovascular disease, high morbidity and disability rate, early detection and treatment is of great significance to the development and prognosis of patients. The clinical evaluation of cerebral vascular narrow narrow common inspection methods have digital subtraction angiography imaging (digital subtraction angiography, DSA (transcranial Doppler), transcranial Doppler, TCD CT angiography (CT), angiography, CTA) and magnetic resonance angiography (magneticresonance angiography MRA), but these tests have shortcomings of one kind or another. High resolution magnetic resonance imaging (high-resolution, MRI, HRMRI) angiography is new, not only can the lumen of imaging, but also can directly show the wall structure, has been maturely applied in extracranial carotid arteries can accurately assess carotid artery stenosis Degree. In recent years, with the rapid development of high field MRI scanners, HRMRI has been serving the large intracranial arteries. The middle cerebral artery (middle cerebral, artery, MCA) is a direct continuation of the internal carotid artery in intracranial atherosclerosis and other diseases, is the most easy to invade and blood vessels, according to the report, MCA atherosclerotic stenosis is the most common cause of ischemic cerebrovascular disease. So, how to HRMRI in assessing the effectiveness of large intracranial artery stenosis? In addition, the daily work, clinicians often encountered similar problems, namely, the severity of the preponderant part of patients with vascular stenosis, cerebral infarction, and the other part of patients showed only TIA how to explain this phenomenon, what? The degree of stenosis of the vessel in patients with cerebral infarction and TIA patients had no difference?
In view of the above questions, this study includes two aspects. It aims to explore the diagnostic value of HRMRI for stenosis or occlusion of middle cerebral artery (MCA) and the difference between MCA stenosis and cerebral infarction and TIA caused by atherosclerotic stenosis.
objective
To investigate the value of HRMRI diagnosis of middle cerebral artery stenosis or occlusion. Methods: collected from October 2012 -2013 year in October in our hospital treated 55 cases of interventional radiology by MRA or CTA confirmed MCA M1 segment stenosis caused by transient ischemic attack or cerebral infarction patients, 33 cases were male, 22 were female, age 17-68 years old. An average of 44.8 years. All patients underwent MRA, HRMRI and DSA, the mean time between 3.4 days. With DSA as the gold standard, combined with analysis of MRA HRMRI in diagnosis of artery stenosis in different degrees in the brain.
Result
55渚嬫?zhèn)ｈ�呮湁55鏀ぇ鑴戜腑鍔ㄨ剦(MCA)鍦∕RA,HRMRI鍜孌SA涓婂潎鍙戠幇綆¤厰鐙獎.鍏朵腑鏈

本文編號：1673169