本文選題：大腦中動(dòng)脈 + 頸內(nèi)動(dòng)脈��； 參考：《中風(fēng)與神經(jīng)疾病雜志》2017年05期

【摘要】：目的探討癥狀性大腦中動(dòng)脈(MCA)狹窄患者顱內(nèi)外動(dòng)脈管壁病變特點(diǎn)和3.0T高分辨磁共振成像(High-resolution magnetic resonance imaging,HRMRI)頭頸聯(lián)合技術(shù)的臨床應(yīng)用價(jià)值。方法 11例癥狀性MCA狹窄患者接受三維增強(qiáng)磁共振血管成像(3D ce-MRA)與3.0T HRMRI的T_1w-db SPACE平掃和T_1w-db SPACE增強(qiáng)掃描,并結(jié)合頭頸部顱內(nèi)外動(dòng)脈管壁不間斷聯(lián)合掃描新技術(shù)。結(jié)果共掃描11例患者的88處顱內(nèi)外動(dòng)脈管壁,其結(jié)果發(fā)現(xiàn):1例中樞神經(jīng)系統(tǒng)血管炎,其左側(cè)MCA及左側(cè)頸內(nèi)動(dòng)脈(ICA)顱內(nèi)段在T_1w-db SPACE像上表現(xiàn)為管壁環(huán)形增厚及環(huán)形強(qiáng)化;1例顱內(nèi)動(dòng)脈夾層,其左側(cè)MCA在T_1w-db SPACE像呈長(zhǎng)條狀高信號(hào),相應(yīng)高信號(hào)在T_2wdb SPACE像上為等低信號(hào);9例動(dòng)脈粥樣硬化患者均合并雙側(cè)MCA粥樣硬化斑塊,表現(xiàn)為管壁偏心性增厚,其中8例(88.9%)合并顱內(nèi)外動(dòng)脈粥樣硬化,增強(qiáng)掃描見(jiàn)6例(67%)顱內(nèi)外動(dòng)脈粥樣硬化斑塊均有強(qiáng)化。比較3D ceMRA與HRMRI結(jié)果發(fā)現(xiàn),88處血管中,23處血管的3D ce-MRA與HRMRI均未見(jiàn)明顯異常;31處血管的3D ceMRA與HRMRI顯示相對(duì)一致,即3D ce-MRA顯示狹窄或者擴(kuò)張、HRMRI顯示管壁呈不同程度的增厚或附壁斑塊;34處血管的3D ce-MRA與HRMRI顯示欠一致,其中,26處血管的3D ce-MRA大致正常而HRMRI顯示管壁增厚(5處)或斑塊(21處),8處血管的3D ce-MRA顯示輕度狹窄(6處)或擴(kuò)張(2處)而HRMRI顯示管腔外徑及管壁均大致正常。判斷顱內(nèi)外動(dòng)脈異常的組間一致性可(3D ce-MRA、HRMRI的Kappa值分別為0.67、0.69,P0.001)。結(jié)論 3.0T HRMRI頭頸聯(lián)合技術(shù)可清晰地顯示顱內(nèi)外動(dòng)脈的管壁結(jié)構(gòu)和病變特點(diǎn),識(shí)別3D ce-MRA未能發(fā)現(xiàn)的狹窄,甄別動(dòng)脈狹窄的病因,對(duì)顱內(nèi)外動(dòng)脈管壁病變的診斷具有較高的臨床應(yīng)用價(jià)值。
[Abstract]:Objective to investigate the characteristics of intracranial and external arterial wall lesions in patients with symptomatic middle cerebral artery stenosis and the clinical value of 3.0T high-resolution magnetic resonance imagingHRMRI technique. Methods 11 patients with symptomatic MCA stenosis underwent 3D enhanced magnetic resonance angiography (3D-ce-MRA), 3.0T HRMRI T_1w-db SPACE plain scan and T_1w-db SPACE enhanced scan. Results A total of 88 intracranial and external arterial walls were scanned in 11 patients, and 1 case of CNS vasculitis was found. On T_1w-db SPACE images, the left MCA and left internal carotid artery (ICA) segments were shown as annular thickening of the wall and circular enhancement of intracranial artery dissection. The left MCA showed long and high signal intensity on T_1w-db SPACE images. On T_2wdb SPACE images, 9 patients with atherosclerotic atherosclerosis were associated with bilateral MCA atherosclerotic plaques, with eccentric thickening of the wall, of which 8 patients were associated with atherosclerosis of the extracranial and intracranial arteries. Contrast-enhanced scans showed 6 cases of atherosclerotic plaques in the intracranial and external arteries. The results of 3D ceMRA and HRMRI showed that there was no obvious abnormality in 3D ce-MRA and HRMRI in 23 vessels in 88 vessels. The 3D ceMRA and HRMRI showed the same in 31 vessels. In other words, 3D ce-MRA showed stenosis or dilatation in different degree of thickening of the vessel wall or 3D ce-MRA of 34 vessels attached to the wall was not consistent with HRMRI. The 3D ce-MRA of 26 vessels was normal and HRMRI showed thickening of the wall in 5) or the 3D ce-MRA of 8 vessels in 21 lesions showed slight stenosis in 6 or dilated in 2) and HRMRI showed the diameter of the lumen and the wall of the vessel were normal. The Kappa values of 3D ce-MRA-HRMRI for the diagnosis of abnormal intracranial and external arteries were 0.670.69 and P 0.001, respectively. Conclusion 3.0T HRMRI combined with head and neck technique can clearly display the wall structure and pathological features of the external intracranial artery, identify the stenosis that can not be found by 3D ce-MRA, and identify the etiology of artery stenosis. It has a high clinical value in the diagnosis of intracranial and external arterial wall diseases.
【作者單位】： 北京大學(xué)深圳醫(yī)院神經(jīng)內(nèi)科;汕頭大學(xué)醫(yī)學(xué)院;中國(guó)科學(xué)院深圳先進(jìn)技術(shù)研究院;
【基金】：深圳市戰(zhàn)略新興產(chǎn)業(yè)發(fā)展專項(xiàng)資金(No.JYCJ20150605103420338)
【分類號(hào)】：R445.2;R743.3

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