本文關(guān)鍵詞： 核磁共振 腦動(dòng)脈夾層 早期診斷　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:探討腦動(dòng)脈夾層(cerebral artery dissection CAD)的特點(diǎn)及多模式核磁共振技術(shù)在CAD早期診斷中的應(yīng)用價(jià)值。研究方法:收集2014-1到2016-12青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院神經(jīng)科收治的腦動(dòng)脈夾層患者46例,均經(jīng)顱腦及頸部核磁共振檢查并經(jīng)全腦血管DSA檢查確診。以DSA檢查作為“金標(biāo)準(zhǔn)”,對(duì)比DSA檢查,分析核磁共振對(duì)頸內(nèi)動(dòng)脈及椎-基底動(dòng)脈夾層診斷的優(yōu)勢(shì)及敏感性,所得數(shù)據(jù)均采用SPSS19.0統(tǒng)計(jì)軟件進(jìn)行分析處理、比較,差異顯著性采用X2檢驗(yàn)。研究結(jié)果:1.MRI在常規(guī)頸部橫斷位T1加權(quán)和T2加權(quán)像上,夾層表現(xiàn)為動(dòng)脈壁的新月形高信號(hào),T2加權(quán)成像在夾層分離導(dǎo)致的內(nèi)膜瓣比X線數(shù)字減影(DSA)準(zhǔn)確性好。2.MRA即磁共振血管成像,表現(xiàn)為血管閉塞動(dòng)脈、動(dòng)脈瘤樣擴(kuò)張、線珠征或者假性動(dòng)脈瘤等多種不同征象。3.3D-HR-MRI即高分辨核磁成像,對(duì)血管壁周圍結(jié)構(gòu)及血管壁的辨別性更好,能更準(zhǔn)確地發(fā)現(xiàn)管腔偏心狹窄、管壁內(nèi)血腫或閉塞,或血栓或內(nèi)膜片等影像學(xué)特征性征象。如果我們懷疑患者可能患有顱內(nèi)外血管夾層,應(yīng)首先行頭頸部的MRA/MRI、頭顱MRI,可提供梗死的部位以及供血血管的截面,在軸位壓脂相上可以見到血管壁內(nèi)血腫,依據(jù)CAD的發(fā)生病理機(jī)制不同,表現(xiàn)為不同的影像學(xué)特點(diǎn),所以對(duì)壁內(nèi)血腫的鑒別分析是診斷腦動(dòng)脈夾層的關(guān)鍵點(diǎn)之一。一旦表現(xiàn)出壁內(nèi)血腫的特征,就明確支持腦動(dòng)脈夾層的診斷;當(dāng)斑塊形態(tài)類似于夾層血腫范圍時(shí),夾層血腫與斑塊內(nèi)出血可用DWI來協(xié)助診斷,并且為準(zhǔn)時(shí)正確治療提供重要的信息。頭頸部磁共振血管成像亦可顯示血管擴(kuò)張或狹窄或者閉塞情況;并且可以作為隨診、篩查以及動(dòng)態(tài)監(jiān)測(cè)的較好方法;研究結(jié)論:在本研究中,多模式核磁共振檢查技術(shù)無創(chuàng)、依從性好,對(duì)CAD早期診斷的敏感性及特異性較理想,聯(lián)合DSA相互補(bǔ)充,提高了早期確診率及治愈率,正因?yàn)楸趦?nèi)血腫是腦動(dòng)脈夾層的特征性表現(xiàn)之一,多模式核磁共振成像具有準(zhǔn)確判斷壁內(nèi)血腫的特點(diǎn),若核磁無法明確診斷需進(jìn)一步明確診斷或需介入治療,可進(jìn)一步行DSA檢查,所以推薦作為早期診斷CAD患者的首選檢查方法。
[Abstract]:Objective: to investigate the characteristics of cerebral artery dissection CAD (cerebral artery dissection) and the value of multimode MRI in the early diagnosis of CAD. Methods: brain samples were collected from the Department of Neurology, affiliated Hospital of Qingdao University from 2014-1 to 2016-12. 46 patients with arterial dissection, All of them were diagnosed by MRI and DSA. The advantage and sensitivity of MRI in the diagnosis of internal carotid artery and vertebrobasilar artery dissection were analyzed by comparing DSA with DSA as "gold standard". The data were analyzed and processed by SPSS19.0 statistical software, and the difference was analyzed by X2 test. Results: 1. The results showed that: 1. MRI was performed on T 1 weighted and T 2 weighted images of the normal cervical transection. Crescent high-signal T 2-weighted imaging of dissected artery wall is more accurate than digital subtraction imaging (DSAA). 2. MRA, I. e., magnetic resonance angiography, shows artery occlusion and aneurysm dilatation. Linear bead sign or pseudoaneurysm. 3.3D-HR-MRI, or high-resolution nuclear magnetic resonance imaging, can distinguish the structure and wall of vascular wall better, and can more accurately detect the eccentric stenosis of the lumen, hematoma or occlusion in the wall. If we suspect that a patient may have a dissection of the intracranial or external vessels, we should first perform the head and neck MRI, the head MRI, to provide the location of the infarction and the section of the blood supply vessel. The intramural hematoma can be seen in the adipose phase of the axial position. According to the pathogenetic mechanism of CAD, there are different imaging features. Therefore, the differential analysis of intracerebral hematoma is one of the key points in the diagnosis of cerebral artery dissection. Once it shows the characteristics of intracerebral hematoma, it clearly supports the diagnosis of cerebral artery dissection; when the plaque shape is similar to the area of dissecting hematoma, Dissection hematoma and plaque hemorrhage can be diagnosed by DWI and provide important information for timely and correct treatment. MRI can also show vasodilation or stenosis or occlusion, and can be used as follow-up. Conclusion: in this study, multimode nuclear magnetic resonance (MRI) technique is noninvasive, good compliance, good sensitivity and specificity for early diagnosis of CAD, and combined with DSA to complement each other. The early diagnosis rate and cure rate were improved. Because intramural hematoma is one of the characteristic manifestations of cerebral artery dissection, multimode magnetic resonance imaging has the characteristics of accurately judging intramural hematoma. If the nuclear magnetic field can not make a definite diagnosis, it is necessary to make further diagnosis or interventional therapy, so it is recommended to be the first choice in the early diagnosis of CAD patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743;R445.2

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