本文選題：椎基底動(dòng)脈延長(zhǎng)擴(kuò)張癥 + 磁共振血管造影　； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景：椎基底動(dòng)脈延長(zhǎng)擴(kuò)張癥(vertebrobasilar dolichoectasia, VBD)是一種少見(jiàn)的原因不明的后循環(huán)血管結(jié)構(gòu)異常性疾病,以椎基底動(dòng)脈顯著延長(zhǎng)、擴(kuò)張、扭曲或成角為主要表現(xiàn),Morgagni1761年首次報(bào)道。隨著VBD病例的不斷報(bào)道,對(duì)其病因、發(fā)病機(jī)制及病理研究的不斷深入,發(fā)現(xiàn)VBD可能是由動(dòng)脈壁缺陷、高血壓及動(dòng)脈粥樣硬化等多重因素的共同作用所致。多數(shù)VBD患者臨床癥狀不明顯,且無(wú)特異性臨床表現(xiàn),臨床癥狀復(fù)雜多樣,后循環(huán)缺血是其最常見(jiàn)的臨床表現(xiàn)。隨訪發(fā)現(xiàn),椎基底動(dòng)脈延長(zhǎng)擴(kuò)張癥具有較高的死亡率及致殘率,且并無(wú)有效的預(yù)防手段。近年來(lái),顯微神經(jīng)外科和神經(jīng)影像學(xué),尤其是高分辨率MRI、MRA、CTA、DSA等血管結(jié)構(gòu)影像技術(shù)的發(fā)展,推動(dòng)了VBD的病因?qū)W、影像學(xué)診斷及治療的相關(guān)研究。MRA的應(yīng)用大大提高了VBD的診斷率,關(guān)于VBD的報(bào)道逐漸增多,高分辨率MRI結(jié)合MRA可顯示椎動(dòng)脈的結(jié)構(gòu)及其與毗鄰組織的結(jié)構(gòu)關(guān)系,為VBD的診斷提供了客觀的臨床依據(jù)。目的：對(duì)比MRA+MRI和CTA兩種檢測(cè)方法對(duì)VBD的診斷價(jià)值。方法：隨機(jī)選取40例經(jīng)Smoker頭顱CT診斷標(biāo)準(zhǔn)診斷為VBD的患者,分為兩組,其中20例患者采用MRA聯(lián)合MRI平掃,20例患者采用CTA�？偨Y(jié)兩組患者的VBD影像學(xué)形態(tài)特征數(shù)據(jù)(包括：?jiǎn)蝹?cè)椎動(dòng)脈纖細(xì)、瘤樣擴(kuò)張、均勻性增粗、血管壁鈣化、血管壁的粥樣硬化斑塊、腦干受壓、面神經(jīng)或三叉神經(jīng)受壓等),并進(jìn)行對(duì)比分析；總結(jié)兩組患者的VBD臨床表現(xiàn)分型數(shù)據(jù),并進(jìn)行對(duì)比分析,同時(shí)對(duì)兩組患者的影像學(xué)臨床癥狀表現(xiàn)進(jìn)行對(duì)比。結(jié)果：VBD主要靠CTA薄層掃描平掃來(lái)進(jìn)行診斷,顱底、蝶鞍及鞍上池層面顯示后顱窩,偽影較重,基底動(dòng)脈周圍有低信號(hào)的腦脊液做對(duì)比,基底動(dòng)脈迂曲增寬可通過(guò)CTA 2D圖像顯示橫切或斜切增粗的血管結(jié)構(gòu)異常,也可直接顯示血管壁的鈣化,所以CTA可以作為篩查VBD的影像學(xué)檢查方法。MRI常規(guī)序列掃描,由于血管流空效應(yīng),水平位(軸位)圖像上椎基底動(dòng)脈顯示為明顯的黑色低信號(hào),也可顯示管壁變薄、增厚血管壁的粥樣硬化程度及腦干顱神經(jīng)壓迫等情況,可通過(guò)血管及毗鄰組織結(jié)構(gòu)學(xué)異常解釋臨床癥狀,為VBD的診斷提供參考依據(jù)。MRA可清晰地顯示椎基底動(dòng)脈結(jié)構(gòu),在顯示椎基底動(dòng)脈結(jié)構(gòu)形態(tài)上不亞于CTA及DSA,且MRA屬于無(wú)創(chuàng)檢查,無(wú)X線輻射,無(wú)需注射造影劑,無(wú)需擔(dān)心放射及造影劑副反應(yīng)的影響。MRA可結(jié)合MRI平掃圖像顯示迂曲延長(zhǎng)的椎基底動(dòng)脈壓迫毗鄰腦組織的情況,顯示壓迫位置、程度,推斷阻塞性腦脊液循環(huán)障礙或缺血性腦血管事件的原因,并可顯示是否合并其他腦血管疾病,如血管狹窄、血栓形成及動(dòng)脈瘤等。結(jié)論：兩組患者在顯示鈣化及對(duì)顱神經(jīng)壓迫方面存在差異,但在顯示VBD其他影像學(xué)形態(tài)特征上無(wú)明顯差異；兩組患者的VBD臨床表現(xiàn)分型數(shù)據(jù)無(wú)明顯差異,且兩種影像學(xué)檢測(cè)方法都可以很好地反映VBD患者的臨床癥狀表現(xiàn)。因此,在VBD影像學(xué)診斷中,MRI+MRA與CTA具有相似的特異性和敏感性。
[Abstract]:Background: vertebrobasilar dolichoectasia (VBD) is a rare and unexplained posterior circulatory vascular disorder. It is the main manifestation of vertebral basilar artery prolonged, dilatation, distortion or angle formation. It was first reported in Morgagni1761. With the continuous reporting of VBD cases, the etiology and pathogenesis of the vertebral basilar artery were reported. It is found that VBD may be the result of multiple factors such as arterial wall defects, hypertension and atherosclerosis. Most of the patients with VBD have not obvious clinical symptoms, and there are no specific clinical manifestations and complex clinical symptoms. Posterior circulation ischemia is the most common clinical manifestation. Follow up findings, vertebrobasilar artery (vertebrobasilar artery) Prolonged dilatation has a high mortality and disability rate, and there is no effective means of prevention. In recent years, the development of microscopic Department of neurosurgery and neuroimaging, especially high resolution MRI, MRA, CTA, DSA, has promoted the etiology, imaging diagnosis and treatment of VBD, and the application of.MRA has greatly improved the VBD The rate of diagnosis of VBD is increasing. High resolution MRI combined with MRA can show the structure of vertebral artery and its relationship with adjacent tissue, which provides an objective clinical basis for the diagnosis of VBD. Objective: To compare the diagnostic value of two detection methods of MRA+MRI and CTA to VBD. Square method: randomly selected 40 cases of Smoker head CT diagnosis. The patients who were diagnosed with VBD were divided into two groups, of which 20 patients were treated with MRA combined with MRI scan, and 20 patients used CTA. to sum up the morphological features of VBD imaging in two groups (including: unilateral vertebral artery slender, tumor like dilation, uniformity thickening, vascular wall calcification, atherosclerotic plaque in the vascular wall, brain stem compression, facial nerve, or trigeminal nerve. The VBD clinical manifestation data of the two groups of patients were analyzed and compared, and the clinical symptoms of the two groups were compared. Results: the diagnosis of the VBD was mainly by CTA thin scan, the skull base, the sella and the suprasellar pool showed the posterior cranial fossa, the artifacts were heavier and the basement moved. A contrast of low signal cerebrospinal fluid around the vein, the basilar artery circuitous widening can show transverse or thickening vascular abnormalities through the CTA 2D image, and can also direct the calcification of the vascular wall, so CTA can be used as an imaging examination for screening VBD,.MRI routine sequence scanning, the horizontal (axial) image due to the flow effect of blood vessels. The upper vertebral basilar artery is shown as a clear black low signal. It can also show the thinning of the wall of the tube, the degree of atherosclerosis and the oppression of the cranial cranial nerve in the thickened vascular wall. It can explain the clinical symptoms through the abnormalities of blood vessels and adjacent tissue structures, and provide a reference basis for the diagnosis of VBD with.MRA clearly showing the structure of the vertebral basilar artery. The structure of vertebrobasilar artery is no less than CTA and DSA, and MRA is noninvasive, no X-ray, no injection of contrast agent, no need to worry about the effect of radiation and side effects of contrast agent,.MRA can combine MRI plain scan to display the compression of the vertebral basilar artery adjacent to the brain tissue, showing the position of compression, degree, and inferring the obstructive brain. The causes of spinal fluid circulation disorder or ischemic cerebrovascular events can show whether the combination of other cerebrovascular diseases, such as vascular stenosis, thrombosis and aneurysm, etc. conclusion: there are differences in calcification and cranial nerve compression in the two groups, but there are no significant differences in the morphological features of the other images of the VBD; the two groups of patients There is no significant difference in the clinical manifestation data of VBD, and the two imaging methods can reflect the clinical symptoms of VBD patients well. Therefore, in the diagnosis of VBD imaging, MRI+MRA and CTA have similar specificity and sensitivity.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R322.8;R743

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