本文選題：頸動脈斑塊 + 磁共振�。� 參考：《南方醫(yī)科大學》2014年碩士論文

【摘要】：第一部分缺血性卒中患者頸動脈斑塊的MRI表現(xiàn)特征 [研究目的] 通過3.0T MRI多對比序列研究缺血性卒中患者頸動脈斑塊的影像學表現(xiàn),分析斑塊的成分及纖維帽情況,判斷斑塊穩(wěn)定性,定量評價斑塊負荷,比較易損斑塊組與穩(wěn)定斑塊組的斑塊成分特征、斑塊負荷及臨床危險因素是否存在差異。 [材料與方法] 1、研究對象 搜集我院2012年至2013年間神經內科同時滿足以下入選標準的患者共65例,入選標準：1)年齡在18周歲及以上的缺血性卒中和/或TIA患者；2)為近期發(fā)作的缺血性卒中或TIA患者(癥狀發(fā)生在≤14天之內)；3)超聲提示頸動脈存在AS斑塊或內膜中膜厚度(IMT)≥1.5mm所有患者檢查均得到倫理委員會同意并簽署知情同意書。 2、主要設備、掃描序列及參數 使用Philips公司生產的Achieva3.0T磁共振掃描儀、頸動脈專用8通道相控陣表面線圈進行頸動脈MR多序列對比掃描。 掃描序列和參數：頸動脈專用8通道相控陣表面線圈固定患者下頜及頸部,掃描時囑患者保持靜止并盡量減少吞咽動作。對患者的雙側頸動脈先行2D-TOF掃描,MIP法重建MRA圖像以獲得頸動脈分叉的準確位置,在頸動脈分叉層面上下2cm的范圍內行橫軸位3D TOF、T1WI、T2WI、MP-RAGE、3DMERGE掃描,各序列主要參數為：(1)3D TOF, TR/TE20ms/4.9ms, FOV140mm×140mm,層厚2mm；(2)T1WI,四反轉恢復(QIR), TR/TE800ms/10ms, FOV140mm×140mm,層厚2mm；(3)T2M,多層雙反轉恢復(MDIR), TR/TE4800ms/50ms, FOV140mm×140mm,層厚2mm；(4)MP-RAGE,3D FFE, TR/TE10ms/4.8ms, FOV140mm×140mm,層厚2mm;(5)3D MERGE,3D FFE, TR/TE10ms/4.8ms, FOV250mm×160mmX70mm,層厚2mm。 3、頸動脈MRI圖像質量分級評分 按各序列頸動脈MRI圖像質量從差到好分為1-4級分別評為1-4分,由兩名有經驗的放射科醫(yī)師采用雙盲法進行打分,整體圖像質量≤2級則數據將不用于統(tǒng)計。 4、頸動脈斑塊圖像分析及處理 由兩位經過系統(tǒng)培訓的人員利用美國華盛頓大學自主開發(fā)的圖像分析軟件CASCADE對頸動脈MR圖像進行分析。分析人員對所有病例臨床資料等信息采取盲法原則。頸動脈磁共振分析內容包括：1)頸動脈斑塊成分識別：鈣化(Calcification, CA)、富含脂質的壞死核(lipid-rich necrotic core, LRNC)、斑塊內出血(plaque hemorrhage,IPH)及各成分體積、所占管壁百分比；2)頸動脈粥樣硬化斑塊形態(tài)學測量：血管總面積(total vessel area, TVA)、管腔面積(lumen area, LA)、管壁厚度(wall thickness, WT)、管壁面積(wall area,WA)和管壁標準化指數(normalized wall index, NWI);3)頸動脈斑塊表面纖維帽狀態(tài)判斷：完整或者破裂。 5、統(tǒng)計學方法 數據運用SPSS13.0統(tǒng)計軟件包處理。計量資料以均數±標準差(x±s)表示。易損組與穩(wěn)定組之間的頸動脈斑塊負荷指標、臨床危險因素的對比分析使用兩獨立樣本t檢驗、Fisher's確切概率分析、Wilcoxon秩和檢驗等。統(tǒng)計學檢驗均使用雙尾側的檢驗方法,有統(tǒng)計學意義的檢驗水平為P0.05。定量數據的結果取兩名評價者測得的平均值用于分析,定性數據不一致時協(xié)商達成一致意見用于分析。 [結果] 1、65例患者中,59例患者的圖像符合研究要求(除外1例為頸動脈夾層患者,3例圖像質量較差,2例因一側頸動脈數據丟失),年齡約43-83歲,平均62.27±9.99歲,其中男性39例,女性20例。高血壓患者44例,糖尿病患者21例,吸煙患者20例,總膽固醇(TC)4.86±1.23mmol/L,甘油三脂(TG)1.73±1.18/mmol/L,高密度脂蛋白膽固醇(HDL)1.25±0.29mmol/L,低密度脂蛋白膽固醇(LDL)3.09±1.12mmol/L。分析59例患者總體頸動脈斑塊負荷和成分特征；按斑塊穩(wěn)定性分組：易損斑塊組10例,穩(wěn)定斑塊組49例。 2、易損斑塊組與穩(wěn)定斑塊組的斑塊成分的比較：易損斑塊組斑塊內CA、LRNC、IPH的體積及相應的面積比均與穩(wěn)定斑塊組存在著明顯差異(P0.05)。 3、易損斑塊組與穩(wěn)定斑塊組的斑塊負荷的比較：平均血管總面積(TVA)兩者差異無統(tǒng)計學意義(P0.05),而平均管腔面積(LA)及最小管腔面積(minLA)易損斑塊組均小于穩(wěn)定斑塊組,差異有統(tǒng)計學意義(P0.05)；平均管壁面積(WA)、平均管壁厚度(WT)、平均標準化管壁指數(NWI)及最大管壁面積(max WA)、最大管壁厚度(max WT)、最大標準化管壁指數(max NWI)易損斑塊組均比穩(wěn)定組大,差異均有統(tǒng)計學意義(P0.05)。 4、易損斑塊患者與穩(wěn)定斑塊患者的臨床危險因素的差異：除年齡外,兩組其余各危險因素差異無統(tǒng)計學意義(P0.05)。 [結論] 1、將MRI“黑血”、“白血”技術相結合觀察斑塊,能更全面、更準確的觀察管壁結構,分析斑塊的成分及其體積。 2、易損斑塊為斑塊內出血及／或纖維帽破裂的斑塊,其成分較穩(wěn)定斑塊復雜。 3、易損斑塊與穩(wěn)定斑塊的血管負荷指標NWI、WA、WT間有顯著性差異,故可用諸負荷指標評價斑塊。 4、易損斑塊組與穩(wěn)定斑塊組的臨床危險因素無顯著性差異。 第二部分頸動脈斑塊與缺血性卒中的相關性研究 [研究目的] 本實驗旨在通過MRI定量分析,探討卒中患者癥狀側與無癥狀側斑塊的負荷及成分的差別,同時分析斑塊負荷、斑塊成分體積與同側大腦急性梗塞灶體積間的相關性。 [材料與方法] 1、研究對象及分組 研究對象與第一部分相同,65例患者中共61例患者頸動脈圖像納入實驗(除外1例夾層,3例圖像質量較差),但因其中2例患者右側部位頸動脈數據丟失,剩余120側頸動脈斑塊圖像符合研究要求。血管分為2組,癥狀側頸動脈：同側大腦半球頸內動脈系統(tǒng)供血區(qū)發(fā)生缺血性卒中的那側動脈,共有89側血管,其中33側血管相應供血區(qū)發(fā)生了急性腦梗；無癥狀側頸動脈：同側大腦半球頸內動脈供血區(qū)未發(fā)生明顯缺血性腦卒中的那側動脈,共31側。 2、儀器設備及參數 儀器設備及頸動脈MRI掃描同第一部分,頭部采用8通道標準頭部接收線圈。主要成像序列為橫軸位T1W、T2W、T2W FLAIR、DWI、3D TOF MRA。各序列主要參數為：(1) T1WI, TR/TE2000ms/20ms,層厚=6mm,間距=1mm, FOV=240mm×240mm, Matrix=256×256;(2) T2W, TR/TE3000ms/80ms,層厚=6mm,間距=1mm,FOV=240mm×240mm, Matrix=256×256;(3)T2WI FLAIR, TR/TE11000ms/125ms,層厚=6mm,間距=1mm, FOV=240mm×240mm, Matrix=256×256;(4) DWI, TR/TE1910ms/44.4ms,層厚=6mm,間距=1mm, FOV=240mm×240mm;(5)3D TOF MRA, TR/TE20ms/4.9ms。 3、頸動脈MRI圖像質量分級 按各序列頸動脈MRI圖像質量從差到好分為1-4級分別評為1-4分,由兩名放射科醫(yī)師進行打分,整體圖像質量≤2級則數據將不用于統(tǒng)計。 4、圖像數據處理及測量 由兩名擁有5年以上MR診斷經驗的放射科醫(yī)生進行圖像分析,分析人員對病例臨床資料、頸動脈MR圖像等信息采取盲法原則,腦MR圖像分析內容包括：有、無T2W FLAIR高信號及其大��；有無DWI高信號及其大小。頸動脈斑塊MR圖像分析同第一部分。 5、統(tǒng)計學方法 數據應SPSS13.0統(tǒng)計軟件包處理。計量資料以均數±標準差(x±s)表示。卒中側和非卒中側兩組間的頸動脈斑塊負荷、成分差異采用兩獨立樣本t檢驗、Fisher's確切概率檢驗及Wilcoxon秩和檢驗。頸動脈斑塊負荷、斑塊各成分體積與同側大腦DWI高信號病灶體積間的關系采用Spearman相關分析。雙側檢驗以P0.05為差異有統(tǒng)計學意義。 [結果] 1、癥狀側和無癥狀側頸動脈斑塊特征的差異 1.1卒中患者雙側頸動脈各項指標的差異無統(tǒng)計學意義(P0.05)； 1.2癥狀側的頸動脈的管壁面積(WA)、管壁厚度(WT)、管壁標準化指數(NWI)均較無癥狀側高,差異有統(tǒng)計學意義(P0.05),血管總面積(TVA)、管腔面積(LA)在癥狀側和無癥狀側中是沒有統(tǒng)計學差異的(P0.05)； 1.3癥狀側與無癥狀側頸動脈斑塊LRNC、IPH的發(fā)生率兩者間存在顯著性差異,而鈣化、FCR發(fā)生率無統(tǒng)計學意義,而在預測臨床癥狀方面,發(fā)現(xiàn)斑塊內LRNC、纖維帽破裂的優(yōu)勢比分別為8.578,2.125,而IPH均發(fā)生于癥狀側；鈣化、LRNC、IPH體積在兩者間存在顯著性差異,以LRNC和IPH明顯。 2、斑塊負荷與同側急性腦梗死(DWI高信號)體積的相關性,頸動脈斑塊負荷中WT、NWI與同側大腦半球急性腦梗死的體積間呈正相關關系,以Mean NWI為著,相關程度程度較強r=0.625,而Mean LA與同側大腦半球急性腦梗死的體積呈負相關關系,但相關程度一般r=-0.461。 3、頸動脈斑塊成分中鈣化體積、LRNC體積、IPH體積均與同側大腦半球急性腦梗死體積間呈正相關關系,相關程度一般,r值分別為0.533,0.436,0.461。 [結論] 1、癥狀側與無癥狀側的頸動脈斑塊負荷是有差異的,但雙側病變總體呈對稱性改變。 2、癥狀側斑塊成分較無癥狀側復雜,LRNC, IPH與臨床缺血事件的發(fā)生密切相關,FCR一定程度上也提示發(fā)生腦卒中的發(fā)生。 3、同側頸動脈斑塊負荷中WT、NWI值越大,即斑塊負荷越重,相應同側大腦半球頸內動脈供血區(qū)急性腦梗體積越大,而Mean LA值越小,即血管越狹窄,相應同側大腦半球急性腦梗死的體積越大。 4、斑塊成分越復雜,發(fā)生急性缺血事件的可能性越大。
[Abstract]:Part one MRI features of carotid plaques in patients with ischemic stroke
[research purposes]
The imaging findings of carotid artery plaque in ischemic stroke patients were studied by 3.0T MRI multi contrast sequence, the composition of plaque and the condition of fibrous cap were analyzed, plaque stability was judged, plaque load was evaluated, plaque composition characteristics of vulnerable plaque group and stable plaque group were compared, and there was difference between plaque load and clinical risk factors.
[materials and methods]
1, the object of research
A total of 65 patients who met the following criteria for neurology from 2012 to 2013, were selected as criteria: 1) ischemic stroke neutralization / or TIA patients aged 18 and above; 2) ischemic stroke in the near future or TIA patients (symptoms occurring within 14 days); 3) the carotid artery had AS plaque or intima. The thickness of the medial membrane (IMT) was greater than 1.5mm. All patients were approved by the ethics committee and signed informed consent.
2, main equipment, scanning sequence and parameters
The Achieva3.0T MR MRI scanner produced by Philips was used to perform the MR multiple sequence contrast scan of the carotid artery.
Scanning sequence and parameters: the 8 channel phased array surface coil of the carotid artery was used to fix the patient's mandible and neck. The patient kept static and minimized the swallowing. 2D-TOF scan on the bilateral carotid artery of the patient, the MIP method to reconstruct the MRA image to obtain the accurate position of the carotid bifurcation, and the 2cm model at the carotid bifurcation level. 3D TOF, T1WI, T2WI, MP-RAGE, 3DMERGE scan, the main parameters of each sequence are: (1) 3D TOF, TR/TE20ms/4.9ms, FOV140mm x 140mm, layer thick 2mm; (2) four inversion recovery (3); (3) MP-RAGE, 3D FFE, TR/TE10ms/4.8ms, FOV140mm x 140mm, layer thickness 2mm; (5) 3D MERGE, 3D FFE, TR/TE10ms/4.8ms, X *, layer thickness
3, MRI image quality grading of carotid artery
According to the quality of the MRI image of each sequence, the quality of the MRI image was divided into 1-4 points, and two experienced radiologists were scored by double blind method. The overall image quality was less than 2, and the data would not be used for statistics.
4, analysis and treatment of carotid artery plaque image
The MR image of the carotid artery was analyzed by two system trained personnel using the image analysis software CASCADE, which was developed by University of Washington. The analyst took the blind principle for all cases of clinical data. The contents of carotid magnetic resonance analysis included: 1) identification of carotid plaque composition: calcification (Calcification, CA) Lipid-rich necrotic core (LRNC) rich in lipid, hemorrhage (plaque hemorrhage, IPH) and the volume of each component, the percentage of the wall of the tube; 2) the morphological measurement of carotid atherosclerotic plaque: total vascular area (total vessel area, TVA), lumen area (lumen), tube wall thickness, tube wall Wall area (WA) and normalized wall index (NWI); 3) judging the status of fibrous caps on the surface of carotid plaques: complete or ruptured.
5, statistical method
The data were treated with SPSS13.0 statistical software package. The measurement data were expressed with mean standard deviation (x + s). The carotid plaque load index between the vulnerable group and the stable group, the comparative analysis of the clinical risk factors using two independent samples t test, the exact probability analysis of Fisher's, the Wilcoxon rank sum test, and so on. The statistical test used the examination of the double tail side. The test method, the statistical test level is the result of the P0.05. quantitative data, the average value measured by two evaluators is used for the analysis, and the consensus is reached when the qualitative data is inconsistent.
[results]
Of the 1,65 patients, 59 cases were in accordance with the research requirements (excluding 1 cases of carotid artery dissection, 3 cases of poor image quality and 2 cases of loss of carotid artery data), age 43-83 years old, with an average of 62.27 + 9.99 years, including 39 men, 20 women, 44 hypertensive patients, 21 cases of diabetes, 20 cases of smoking, total cholesterol (TC) 4.86 + 1.23mmol/L, glycerol three (TG) 1.73 + 1.18/mmol/L, high density lipoprotein cholesterol (HDL) 1.25 + 0.29mmol/L, low density lipoprotein cholesterol (LDL) 3.09 + 1.12mmol/L. analysis of 59 patients with overall carotid plaque load and composition characteristics, according to plaque stability group: vulnerable plaque group 10 cases, stable plaque group 49 cases.
2, comparison of plaque composition between vulnerable plaque group and stable plaque group: the volume and area ratio of CA, LRNC, IPH and corresponding area in vulnerable plaque group were significantly different from those in the stable plaque group (P0.05).
3, compared with the plaque load in the vulnerable plaque group and the stable plaque group, the average total area of vascular area (TVA) had no significant difference (P0.05), while the average lumen area (LA) and the smallest lumen area (minLA) vulnerable plaque group were less than the stable plaque group, and the difference had the significance (P0.05), the mean tube wall area (WA), and the mean tube wall thickness (WT). The average standardized tube wall index (NWI) and the maximum tube wall area (max WA), the maximum tube wall thickness (max WT), the maximum standardized tube wall index (max NWI) vulnerable plaque group were all larger than the stable group, the difference was statistically significant (P0.05).
4, there were differences in clinical risk factors between vulnerable plaque patients and stable plaque patients: except for age, there was no significant difference in the other risk factors between the two groups (P0.05).
[Conclusion]
1, combining MRI "black blood" and "white blood" technology to observe plaques, we can observe the wall structure more comprehensively and accurately, and analyze the composition and volume of plaques.
2, vulnerable plaque is plaque with hemorrhage and / or fibrous cap rupture, and its composition is more stable than that of plaque.
3, there is a significant difference between vulnerable plaque and stable plaque vascular load index NWI, WA, WT, so the load index can be used to evaluate plaque.
4, there was no significant difference in clinical risk factors between vulnerable plaque group and stable plaque group.
The second part is the correlation between carotid plaques and ischemic stroke.
[research purposes]
The purpose of this study was to investigate the difference in the load and composition of symptomatic and asymptomatic plaques in patients with stroke by MRI quantitative analysis, and to analyze the correlation between plaque load, plaque volume and the volume of acute cerebral infarction in the same side.
[materials and methods]
1, research objects and groups
The subjects were the same as the first part. The carotid artery images of 61 patients in 65 patients were included in the experiment (excluding 1 dissections and 3 cases of poor image quality). However, the carotid artery data in the right part of the 2 patients were lost and the remaining 120 carotid plaques were in accordance with the study requirements. The blood tube was divided into 2 groups, the symptomatic carotid artery: the ipsilateral cerebrum cervix. There were 89 vessels in the artery of the ischemic stroke in the blood supply area of the internal artery system, of which there were acute cerebral infarction in the corresponding blood supply area of 33 vessels, and the asymptomatic lateral carotid artery: there were 31 sides of the artery in the same lateral cerebral hemisphere of the internal carotid artery.
2, instrument and equipment and parameters
The 8 channel standard head receiving coils are used in the first part of the instrument and the MRI scan of the carotid artery. The main imaging sequences are horizontal axis T1W, T2W, T2W FLAIR, DWI, and 3D TOF MRA. sequence main parameters are: (1) T1WI, TR/TE2000ms/20ms, thick =6mm, spacing, 256; (2) =6mm, distance =1mm, FOV=240mm x 240mm, Matrix=256 x 256; (3) T2WI FLAIR, TR/TE11000ms/125ms, layer thickness =6mm, interval =1mm, FOV=240mm * 240mm, 256;
3, MRI image quality classification of carotid artery
According to the MRI image quality of the carotid artery of each sequence from poor to good score of 1-4, the scores were scored 1-4 points respectively. Two radiologists were awarded the score, and the overall image quality was less than 2. The data would not be used for statistics.
4, image data processing and measurement
An image analysis was performed by two radiologists with more than 5 years of MR diagnostic experience. The analyst took the blind principle of the case clinical data and the MR image of the carotid artery. The MR image analysis of the brain included: there was no high signal and size of T2W FLAIR; there was no DWI high signal and its size. The analysis of the MR image of the carotid plaque was the same as the first part. Points.
5, statistical method
The data should be processed by SPSS13.0 statistical software package. The measurement data were represented by mean number + standard deviation (x + s). The carotid plaque load between the two groups of stroke side and non stroke side was measured by two independent sample t test, the exact probability test of Fisher's and the Wilcoxon rank sum test. The carotid plaque load, the volume of plaque and the high DWI in the same side of the brain. The correlation of signal lesion volume was analyzed by Spearman correlation analysis. Bilateral test showed a statistically significant difference between P0.05.
[results]
1, differences in plaque characteristics between symptomatic side and asymptomatic lateral carotid artery.
1.1 there was no significant difference in the indexes of bilateral carotid artery in stroke patients (P0.05).
1.2 the wall area of the carotid artery (WA), the thickness of the tube wall (WT), the tube wall standardization index (NWI) were higher than that of the asymptomatic side (P0.05), the total vascular area (TVA), and the lumen area (LA) in the symptomatic side and asymptomatic side (P0.05).
1.3 there were significant differences in the incidence of LRNC and IPH in symptomatic side and asymptomatic carotid artery plaque, while calcification, and the incidence of FCR were not statistically significant. In predicting the clinical symptoms, LRNC was found in plaque, and the ratio of fibrous cap rupture was 8.578,2.125 respectively, and IPH occurred at the symptomatic side; calcification, LRNC, and IPH volume were stored between the two. In the significant difference, LRNC and IPH are obvious.
2, the correlation between plaque load and the volume of the ipsilateral acute cerebral infarction (DWI high signal), WT, NWI and the volume of acute cerebral infarction in the ipsilateral cerebral hemisphere were positively correlated with the volume of acute cerebral infarction in the same side of the cerebral hemisphere, and the degree of correlation was stronger r=0.625, while Mean LA and the volume of acute cerebral infarction in the same hemisphere were negatively correlated, but the phase of Mean LA was negatively correlated with the volume of acute cerebral infarction in the same hemisphere. General r=-0.461.
3, the volume of calcification, the volume of LRNC, and the volume of IPH in the carotid plaque components were positively correlated with the volume of acute cerebral infarction in the same hemisphere, and the correlation was general, and the R value was 0.533,0.436,0.461., respectively.
[Conclusion]
1, there were differences in carotid plaque burden between symptomatic side and asymptomatic side, but bilateral lesions showed symmetrical changes.
2, the plaque composition on the symptom side is more complicated than the asymptomatic side. LRNC and IPH are closely related to the occurrence of clinical ischemic events. FCR also indicates the occurrence of stroke to some extent.
3, the greater the value of WT and NWI in the ipsilateral carotid artery plaque load, the heavier the plaque load, the greater the volume of acute cerebral infarction in the internal carotid artery supply area of the same hemisphere, and the smaller the Mean LA value, the more narrower the blood vessels are, the larger the volume of the corresponding cerebral hemisphere acute cerebral infarction.
4, the more complex plaque components, the greater the possibility of acute ischemic events.

【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3;R445.2

【參考文獻】

相關期刊論文 前10條

1 蔡劍鳴,高元桂,蔡幼銓,馬林,李雪梅,YUAN Chun;高分辨MRI技術測量頸動脈粥樣硬化血管壁面積的可重復性評價[J];第二軍醫(yī)大學學報;2003年08期

2 徐賢;具海月;王新江;楊波;蔡幼銓;蔡劍鳴;張金山;;3T高分辨MR對頸動脈粥樣硬化斑塊表面鈣化與斑塊穩(wěn)定性的量化分析[J];第二軍醫(yī)大學學報;2008年12期

3 周建軍;王若冰;林江;曾蒙蘇;嚴福華;王建華;周康榮;;頸動脈斑塊脂質和纖維成份高分辨MRI表現(xiàn)及其病理基礎[J];放射學實踐;2011年03期

4 王蘭琴;魏秀娥;榮良群;朱本亮;;腦梗死患者頸動脈斑塊穩(wěn)定性及其相關因素分析[J];中國實用神經疾病雜志;2012年04期

5 王曉剛;周定標;蔡劍鳴;陳穗惠;;高分辨率磁共振對體內頸動脈斑塊大小的量化分析[J];中國臨床醫(yī)學影像雜志;2008年06期

6 崔豹;馬露;曾源;韓旭;李雪梅;蔡劍鳴;;老年高血壓患者頸動脈易損斑塊與近期缺血性腦卒中的相關性[J];中華老年心腦血管病雜志;2013年12期

7 李小龍;;陜西省神木縣全民免費醫(yī)療考察與評價[J];醫(yī)學與社會;2011年01期

8 蔡劍鳴,高元桂,蔡幼銓,馬林,姜金利,李寶民,劉軍,李雪梅,梁麗,梁燕;增強與門控二維時間飛躍法MR血管造影評價頸內動脈狹窄的對比研究[J];中華放射學雜志;2001年09期

9 李明利;朱以誠;馮逢;有慧;胡凌;金征宇;;三英寸表面線圈在磁共振頸動脈斑塊成像中的應用[J];中國醫(yī)學影像技術;2007年12期

10 趙廷強,婁昕,梁燕,蔡幼銓,蔡劍鳴;頸動脈粥樣硬化斑塊高分辨磁共振成像掃描方法[J];中國醫(yī)學影像學雜志;2005年06期

，

本文編號：1829668