【摘要】：目的探討常規(guī)MRI、MR血管成像(MRA)和高分辨MRI診斷致缺血性卒中的顱內(nèi)動(dòng)脈夾層(IAD)的價(jià)值。方法前瞻性連續(xù)納入59例于2008年8月至2015年4月在中山大學(xué)附屬第一醫(yī)院神經(jīng)科住院的IAD致缺血性卒中患者[年齡(45±15)歲,男41例]。所有患者接受常規(guī)頭部MRI/MRA檢查,對(duì)其中25例行全腦DSA檢查,對(duì)10例行高分辨MRI。分析IAD的常規(guī)MRI/MRA和高分辨MRI表現(xiàn)。對(duì)行DSA的患者,比較DSA與常規(guī)MRI/MRA對(duì)典型夾層征象的檢出及符合率。結(jié)果 (1)59例中,常規(guī)MRI/MRA檢測(cè)到42例(71.2%)典型夾層征象,其中以壁內(nèi)血腫(52.4%,22例)最常見(jiàn),其他征象包括內(nèi)膜征/雙腔征(31.0%,13例)和長(zhǎng)段不規(guī)則或絲線樣狹窄(21.4%,9例);而夾層動(dòng)脈瘤(16.7%,7例)和鼠尾狀閉塞(7.1%,3例)相對(duì)少見(jiàn);常規(guī)MRI/MRA未檢測(cè)到典型夾層征象的17例(28.8%)IAD中,夾層累及大腦中動(dòng)脈(64.7%,11/17)較常規(guī)MRI/MRA檢測(cè)到典型夾層征象的42例IAD(23.8%,10/42)更為多見(jiàn),差異有統(tǒng)計(jì)學(xué)意義(χ2=11.325,P=0.006)。(2)25例接受DSA檢查的患者中,15例(60.0%)有典型夾層征象;而常規(guī)MRI/MRA僅檢測(cè)到其中8例(32.0%)有典型夾層征象,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.088)。(3)有10例(16.9%)IAD常規(guī)MRI/MRA和DSA均顯示非特異性局限性狹窄或截?cái)鄻娱]塞,而高分辨MRI檢測(cè)到其中5例有內(nèi)膜征,4例有壁內(nèi)血腫,1例有內(nèi)膜征和壁內(nèi)血腫。結(jié)論常規(guī)頭部MRI/MRA是檢測(cè)IAD的有效技術(shù),而高分辨MRI在診斷其他血管影像學(xué)檢查無(wú)典型夾層表現(xiàn)的IAD方面獨(dú)具優(yōu)勢(shì)。
[Abstract]:Objective to evaluate the value of conventional MRI,MR angiography (MRA) and high resolution MRI in the diagnosis of intracranial artery dissection (IAD) in ischemic stroke. Methods 59 consecutive patients with ischemic stroke caused by IAD from August 2008 to April 2015 were enrolled in the Department of Neurology, first affiliated Hospital of Sun Yat-sen University [age: (45 鹵15) years, male: 41 cases]. All patients underwent routine head MRI/MRA examination, 25 of them underwent whole brain DSA, and 10 underwent high resolution MRI.. The conventional MRI/MRA and high resolution MRI findings of IAD were analyzed. To compare the detection and coincidence rate between DSA and conventional MRI/MRA for typical dissection signs in patients with DSA. Results (1) among the 59 cases, 42 cases (71.2%) were detected typical dissection signs by routine MRI/MRA. The most common sign was intramural hematoma (52.442%), and other signs included intimal sign / double lumen sign (31.0%). 13 cases and 9 cases with long segment irregular or filamentous stenosis (21. 4%); Dissecting aneurysms (16.7 cases) and rat caudate occlusion (7.1 cases) were relatively rare. In 17 cases (28.8%) of IAD without typical dissection signs detected by conventional MRI/MRA, dissection involving middle cerebral artery (64.7 / 17) was higher than that of 42 cases (23.8%) with typical dissection sign detected by conventional MRI/MRA. (10 / 42) the difference was statistically significant (蠂 ~ 2 = 11.325). (~ (0.006). (~ (2). Of the 25 patients undergoing DSA examination, 15 (60.0%) had typical dissection signs. However, only 8 cases (32.0%) were found to have typical dissection signs by conventional MRI/MRA. However, there was no significant difference (P0. 088). (3) in 10 cases (16. 9%) of IAD, both conventional MRI/MRA and DSA showed nonspecific localized stenosis or truncated occlusion, and 5 cases had intimal signs detected by high resolution MRI. 4 cases had intramural hematoma, 1 case had intimal sign and intramural hematoma. Conclusion conventional head MRI/MRA is an effective technique for detection of IAD, while high resolution MRI has a unique advantage in the diagnosis of IAD with no typical dissection in other vascular imaging examinations.
【作者單位】： 中山大學(xué)附屬第一醫(yī)院放射科;中山大學(xué)附屬第一醫(yī)院神經(jīng)內(nèi)科;
【基金】：廣東省醫(yī)學(xué)科研基金項(xiàng)目(B2012083)
【分類(lèi)號(hào)】：R743.3;R445.2

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