液体衰减反转恢复成像-高信号血管征评估成年型烟雾病颅内侧支血流模式的价值  

The value of hyperintense vessel signs on fluid-attenuated inversion recovery imaging for assessing the patterns of collateral blood flow in adult moyamoya disease

作　　者：刘文华[1] 黄显军[1] 李永坤[1] 朱武生[1] 马敏敏[1] 徐格林[1] 刘新峰[1] 

机构地区：[1]南京军区南京总医院神经内科,210002

出　　处：《中华神经科杂志》2012年第11期774-778,共5页Chinese Journal of Neurology

基　　金：江苏省自然科学基金（重点项目）资助项目（BK2010067）

摘　　要：目的探讨MRI-液体衰减反转恢复（FLAIR）序列．高信号血管征（hyperintense vessel signs，HVS）评估烟雾病患者颅内侧支血流模式的价值。方法从南京卒中注册系统中提取2008年8月至2011年1月经脑血管造影诊断，且实施了MRI—FLAIR序列检查的41例非脑出血性成年型烟雾病患者临床资料。根据HVS在大脑中动脉供血区域分布部位的不同，将其分布模式分为0-3级：0级是指缺乏HVS；1级是指HVS主要分布在颞叶脑沟和外侧裂区域；2级是指HVS主要分布在顶、额叶脑沟和外侧裂区域；3级是指HVS分布于1级和2级联合的区域。另外，依据脑血管造影结果，将继发于血管狭窄和闭塞的颅内侧支血流模式分为1-3型：第1型为通过病变血管或其周围的新生血管形成的顺向性残余血流；第2型为通过软膜血管形成的逆向性血流；第3型为第1和第2型联合组成的混合性血流。分析烟雾病患者颅内侧支血流模式与HVS分布之间的关系。结果在41例非出血性成年型烟雾病患者中，3例为单侧病变，38例为双侧血管病变，故存在烟雾血管的半球数为79侧；因3例患者双侧大脑半球表现HVS缺如，故存在HVS的半球数为73侧，HVS阳性率达92．4％（73／79）。重要的是，1级HVS对应的均是缓慢的顺向性血流（7／7）；2级HVS主要对应的是缓慢的逆向性软脑膜血流（95．0％，19／20）；3级主要对应的是缓慢的混合性血流（84．8％，39／46）。且随着HVS分布从颞叶脑沟转移至额、顶叶脑沟，侧支血流的方向由顺向转变为逆向，此转变趋势有统计学意义。结论不同分布部位的HVS反映了不同模式的侧支血流，HVS能无创评估成年型烟雾病患者颅内侧支血流方向。Objective To investigate the value of hyperintense vessel signs （HVS） on fluidattenuated inversion recovery （FLAIR） sequence for assessing the patterns of collateral blood flow in adult moyamoya disease （MMD）. Methods Forty-one adult patients with non-hemorrhagic MMD retrieved from Nanjing Stroke Registry Program between August 2008 and January 2011 were identified by digital cerebral angiography and performed the examination of FLAIR sequence in Jinling hospital. According to the different sites of HVS located in the territory of the middle cerebral artery, the patterns of HVS were classified into grades 0--3 ： Grade 0, absence of HVS ; Grade 1, HVS limited in the cerebral sulci of temporal lobe and Sylvian fissure ; Grade 2, HVS in the cerebral sulci of frontal and parietal lobe regions and Sylvian fissure ; and Grade 3, HVS in the combined territories of Grade 1 and Grade 2. According to the intracerebral collateral blood flow, steno-occlusions of the arteries were classified into three types： Type 1, residual antegrade flow across steno-occlusive lesions ; Type 2, retrograde flow via leptomeningeal vessels ; Type 3, the combined collateral blood flow of Type 1 and Type 2. The relationship between the patterns of intracerebral collateral blood flow and the location of HVS was analyzed. Results Of 41 aduh patients with non-hemorrhagic MMD, there were 3 patients presented with unilateral vascular lesions and 38 with bilateral vascular lesions, so the total number of vascular lesions of the cerebral hemispheres was 79. Because three patients showed the absence of HVS in bilateral hemispheres, the total number of the presence of HVS of the cerebral hemispheres was 73. Therefore, the percentage of the presence of HVS was 92. 4% （73/79） in vascular lesions of the cerebral hemispheres. Importantly, the patterns of slow collateral blood flow corresponding to Grade 1 HVS were all antegrade （7/7） ; the collateral patterns corresponding to Grade 2 HVS were mainly retrograde leptomeningeal flow （

关 键 词：脑底异常血管网病 大脑中动脉 局部血流 磁共振成像 脑血管造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]