本文選題：顱內動脈瘤 + 磁共振血管成像��； 參考：《中國人民解放軍醫(yī)學院》2015年碩士論文

【摘要】：研究背景：磁共振血管成像是顱內未破裂動脈瘤篩查的重要技術之一,它具有無創(chuàng)、無輻射、無需靜脈給藥等優(yōu)點,受到臨床親睞。但既往磁共振場強較低,成像質量不高,磁共振血管成像的敏感度無法和數(shù)字減影血管造影術及CT血管成像術相比。近年來,3T磁共振的臨床應用及新的血管成像技術的發(fā)展,使得磁共振在顱內未破裂動脈瘤的形態(tài)和破裂風險的評估中發(fā)揮越來越重要的作用。目的：1.以DSA成像作為參照,在3TMRA上測量動脈瘤的瘤頸、瘤體橫徑及頂徑距這三個形態(tài)學指標,評估兩者之間的差異;2.在高分辨磁共振上判斷瘤壁的薄弱部位、瘤壁增強顯影情況、并探索磁共振影像與術中所見的相關性。方法：第一部分 16例顱內未破裂動脈瘤患者行DSA和MRA檢查,分別在DSA和MRA上測量瘤頸、瘤體橫徑及頂徑距這三個參數(shù)。將三個參數(shù)分別進行統(tǒng)計分析,判斷兩種檢查是否存在統(tǒng)計學差異。第二部分 16例患者均行高分辨血管壁成像(MSDE序列)及增強(CE MSDE)掃描,在MSDE序列上根據(jù)瘤壁顯影情況分級：瘤壁顯影≥60%為Ⅰ級。30%-60%瘤壁顯影為Ⅱ級,≤30%瘤壁顯影為Ⅲ級：對比MSDE和CE MSDE上瘤壁顯影情況分為“明顯強化”、“一般強化”和“無強化”三組：16例患者中有12例行開顱手術,根據(jù)術前磁共振上對瘤壁厚度判斷情況與術中所見對比,結果分為三類：與預期一致,與預期相符,與預期不同。結果：第一部分 瘤頸平均值：DSA為9.29±4.04mm, MRA為8.93±4.72mm,差異無統(tǒng)計學意義(Z=-1.19,P=0.2340.05,r=0.968)；瘤體橫徑平均值：DSA為12.65±6.86mm, MRA為12.91±6.83mm,兩者差異無統(tǒng)計學意義(Z=-0.88,P=0.3790.05,r=0.933);頂頸距平均值：DSA為14.23±0.95mm, MRA為13.86±0.96mm,兩者差異無統(tǒng)計學意義(Z=-1.48,P=0.140.05,r=0.499)。第二部分MSDE序列上2例瘤壁1級顯影,8例瘤壁2級顯影,6例瘤壁3級顯影；CE MSDE上瘤壁1級顯影12例,2級顯影3例,3級顯影1例;在CE MSDE序列上2例瘤壁明顯強化,11例一般強化,3例無強化;在12例開顱手術病例中,7例術中所見與預期一致,3例與預期相符,2例與預期不符。結論：3T磁共振上MRA是評估動脈瘤形態(tài)的有效檢查;動脈瘤的高分辨MSDE和CE MSDE圖像能提供動脈瘤壁的重要信息,有助于未破裂動脈瘤的手術策略制定和動脈瘤破裂風險的評估。
[Abstract]:Background: magnetic resonance angiography (MRA) is one of the important techniques for the screening of intracranial unruptured aneurysms. It has the advantages of non-invasive, non-radiation and no intravenous administration. However, the sensitivity of Mr angiography can not be compared with that of digital subtraction angiography and CT angiography. In recent years, the clinical application of 3T magnetic resonance imaging and the development of new angiography technology make MRI play an increasingly important role in the evaluation of the morphology and risk of rupture of intracranial unruptured aneurysms. Purpose 1. The aneurysm neck, transverse diameter and parietal diameter of the aneurysm were measured on 3T MRA with DSA imaging as the reference, and the difference between them was evaluated. The weak position of the tumor wall and the enhancement of the tumor wall were determined on high resolution MRI, and the correlation between MRI and intraoperative findings was explored. Methods: in the first part, DSA and MRA were performed in 16 patients with unruptured intracranial aneurysms. The tumor neck, transverse diameter and parietal diameter were measured on DSA and MRA respectively. The three parameters were statistically analyzed to determine whether there were statistical differences between the two tests. In the second part, all 16 patients underwent high-resolution angiography (MSDE) and enhanced angiography (CE MSDE). According to the development of the tumor wall on the MSDE sequence, the tumor wall development 鈮，

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