三维高分辨MR成像诊断及随访颅外段颈内动脉夹层四例  

High-resolution MR imaging for diagnosis and follow-up study in 4 patients with extracranial internal carotid artery dissection

作　　者：万敏[1] 刘江涛[2] 郭秀海[1] 李坤成[2] 贾建平[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院放射科,北京100053

出　　处：《中国脑血管病杂志》2011年第10期539-543,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市科技新星计划(2005B53);北京市"215"高层次技术人才队伍建设工程培养计划

摘　　要：目的探讨颅外段颈内动脉夹层(ICAD)的特点及三维高分辨MR成像(3D HR-MRI)在诊断及随访中的应用价值。方法 4例临床或其他影像学初步诊断为颅外段ICAD患者,经3D HR-MRI检查明确诊断,给予抗凝或抗血小板聚集治疗4～9个月,随访其临床表现,采用美国国立卫生研究院卒中量表(NIHSS)进行临床预后评估,并复查3D HR-MRI观察病变血管壁内血肿变化的情况。结果①4例患者均接受3D HR-MRI检查,各序列轴位均可见"双腔征"及强度较均匀、稍高信号半月形壁内血肿;②4例患者临床预后均较好;③4例患者中,3例ICAD后动脉狭窄的患者,复查其血管壁内血肿均明显缩小;甚至完全消失;1例ICAD后真腔内血栓形成致动脉闭塞的患者,复查时闭塞远段部分再通。结论 3D HR-MRI能够很好地进行颅外段ICAD的诊断及随访。及时诊治颅外段ICAD预后可能较好。Objective To investigate the characteristics of extraeranial internal carotid artery dissec- tion （ICAD） and the application value of high-resolution MR imaging （HR-MRI） in the diagnosis and follow-up study. Methods Four patients with extraeranial ICAD were diagnosed by clinical and imaging and confirmed by 3D-HR-MRI. They received anticoagulant or antiplatelet therapies for 2 to 9 months and their clinical manifestations were followed up. Their prognostic evaluation was conducted using the National Institutes of Health Stroke Scale （NIHSS） , and reexamined with 3D-HR-MRI for observing the changes of hematoma in the vascular walls. Results ①All the 4 patients was detected by 3D-HR-MRI. The ＂double-lumen sign＂ and the ＂half-moon＂ shaped intramural hematoma with uniform strength and slightly higher signal could be seen on each axial sequence. ②The clinical prognosis of the 4 patients were good. ③The intramural hematomas were reexamined in 3 patients, their hematomas were significantly reduced or com- pletely disappeared. One patient with true lumen thrombosis caused arterial occlusion had distal recanalization during the reexamination. Conclusion HR-MRI may conducts the diagnosis and follow-up study of the extraeranial ICAD. The prognosis of the extracranial ICAD may be good if it is diagnosed and treated promptly.

关 键 词：动脉瘤 夹层 颈内动脉破裂 磁共振成像 诊断 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]