【摘要】：目的： 1.探討MRI顱內高信號血管征(hyperintense vessel sign, HVS)與頸內動脈(internal carotid artery, ICA)狹窄程度的相關性,揭示HVS的形成機制及臨床意義。 2.觀察頸動脈內膜剝脫術(carotid endarterectomy, CEA)前后HVS的變化,探討HVS對CEA的價值。 方法： 回顧性分析1221例行頸動脈血管成像及頭顱MRI液體衰減翻轉恢復(fluid-attenuated inversion recovery, FLAIR)序列檢查患者的影像學資料,并對83例行CEA的ICA狹窄患者術前術后影像學資料進行對照分析。病例資料的納入標準：(1)患者有完整的頭頸部CTA或頭頸部MRA資料,以及頭顱MRI(含F(xiàn)LAIR序列)資料；(2)頭頸部CTA或MRA圖像顯示雙側大腦中動脈(Middle cerebral artery, MCA)無狹窄；(3)CEA術后復查頭頸部CTA及頭顱MRI均在術后3天內完成。 根據(jù)有無ICA狹窄,將患者資料分為ICA狹窄組及ICA無狹窄組,ICA狹窄組進一步分為單側ICA狹窄組及雙側ICA狹窄組。采用χ2檢驗分析ICA狹窄組與ICA無狹窄組、單側ICA狹窄組與雙側ICA狹窄組之間HVS的發(fā)生率的差異。根據(jù)有無Willis、環(huán)側支血流,將單側ICA狹窄組中狹窄程度70%的病例分為有Willis環(huán)側支血流組和無Willis環(huán)側支血流組,采用χ2檢驗分析兩組之間HVS發(fā)生率的差異。在單側ICA狹窄組中,根據(jù)ICA狹窄程度分為七個等級,即50%、50%～59%、60%～69%、70%～79%、80%～89%、90%～99%、100%,采用Spearman等級相關分析HVS陽性率與ICA程度之間的相關性。對照分析83例CEA手術前后FLAIR圖像,觀察HVS的變化。 結果： 1.ICA狹窄組HVS陽性率41.12%(125/304),ICA無狹窄組HVS陽性率11.78%(108/917),ICA狹窄組HVS的陽性率顯著高于ICA無狹窄組(χ2=127.289,P0.001)。 2.單側ICA狹窄組HVS陽性率39.3%(90/229),雙側ICA狹窄組HVS陽性率48%(36/75),兩組之間HVS陽性率無統(tǒng)計學意義(χ2=1.762,P0.05)。 3.單側ICA狹窄組ICA狹窄程度各等級的HVS陽性率依次為15.38%、12.9%、38.46%、33.33%、41.67%、67.86%、85.71%,HVS陽性率與ICA狹窄程度呈顯著正相關關系(r=0.929,P0.001)。 4.單側ICA狹窄組中ICA狹窄程度70%的病例94例,有Willis環(huán)側枝血流組HVS陽性率56.25%(36/64)；無Willis環(huán)側枝血流組HVS陽性率93.33%(28/30)。無Willis環(huán)側枝血流組HVS的陽性率顯著高于有Willis環(huán)側枝血流組(χ2=12.927,P0.001) 5.CEA術前40例HVS陽性,術后31例HVS消失,HVS仍然存在的9例與CEA手術部位遠端的血管狹窄相關。 結論： 1.MRI顱內FLAIR序列出現(xiàn)HVS提示ICA可能存在嚴重狹窄,進一步針對ICA的評估是非常必要的。 2.CEA術后HVS消失,可成為評估CEA手術效果的有效指標之一。
[Abstract]:Objective: 1. To investigate the correlation between intracranial hyperintense vascular sign (hyperintense vessel sign, HVS) and stenosis of internal carotid artery (internal carotid artery, ICA) in MRI, and to reveal the mechanism and clinical significance of HVS. 2. To observe the changes of HVS before and after carotid endarterectomy before and after (carotid endarterectomy, CEA), and to explore the value of HVS in CEA. Methods: the imaging data of 1221 patients with carotid angiography and MRI fluid attenuated inversion (fluid-attenuated inversion recovery, FLAIR) were retrospectively analyzed. The imaging data of 83 CEA patients with ICA stenosis before and after operation were analyzed. The inclusion criteria of case data were as follows: (1) complete CTA or MRA data of head and neck, and MRI (including FLAIR sequence) of head and neck, (2) CTA or MRA images of head and neck showed no (Middle cerebral artery, MCA) stenosis in bilateral middle cerebral artery (MCA). (3) CTA and MRI of head and neck were completed within 3 days after CEA. According to ICA stenosis, the patients were divided into ICA stenosis group and ICA without stenosis group. ICA stenosis group was further divided into unilateral ICA stenosis group and bilateral ICA stenosis group. The incidence of HVS in ICA stenosis group and ICA without stenosis group, unilateral ICA stenosis group and bilateral ICA stenosis group were analyzed by 蠂 2 test. According to the Willis, annular collateral blood flow, 70% of the patients with unilateral ICA stenosis were divided into Willis ring collateral blood flow group and no Willis ring collateral blood flow group. The difference of HVS incidence between the two groups was analyzed by 蠂 2 test. In the unilateral ICA stenosis group, according to the degree of ICA stenosis, they are divided into seven levels, namely, 50 and 50. Spearman grade correlation was used to analyze the correlation between HVS positive rate and ICA degree. FLAIR images of 83 cases with CEA before and after operation were analyzed and the changes of HVS were observed. Results: the positive rate of HVS in patients with 1.ICA stenosis was 41.12% (125 / 304), ICA) and the positive rate of HVS was 11.78% (108 / 917), ICA stenosis), which was significantly higher than that in ICA without stenosis (蠂 2 / 127.289 P 0.001). 2. The positive rate of HVS in unilateral ICA stenosis group was 39.3% (90 / 229), and that in bilateral ICA stenosis group was 48% (36 / 75). There was no significant difference in HVS positive rate between the two groups (蠂 2, 1.762P 0.05). 3. In the unilateral ICA stenosis group, the positive rate of HVS in each grade of ICA stenosis was 15.38 and 12.9, and the positive rate was 38.463.33 and 41.676.86 and 85.71, respectively. The positive rate of HVS was positively correlated with the degree of ICA stenosis (r = 0.929, P 0.001). 4. In the unilateral ICA stenosis group, the positive rate of HVS was 56.25% (36 / 64) in the ICA stenosis group and 93.33% (28 / 30) in the non-Willis loop collateral blood flow group, and the positive rate of HVS was 56.25% (36 / 64) in the ICA stenosis group and 93.33% (28 / 30) in the non-Willis loop collateral flow group. The positive rate of HVS in the blood flow group without Willis ring was significantly higher than that in the Willis ring collateral blood flow group (蠂 2 + 12.927% P0.001). The positive rate of HVS was found in 40 cases before and after the operation of 5.CEA, and the HVS disappeared in 31 cases after operation. The presence of HVS in 9 cases was related to the stenosis of the distal end of CEA. Conclusion: the presence of HVS on intracranial FLAIR sequence in 1.MRI suggests that ICA may have severe stenosis, and it is necessary to evaluate ICA further. The disappearance of HVS after 2.CEA may be one of the effective indexes to evaluate the effect of CEA.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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