多模式动态影像学诊断椎动脉夹层的临床价值  

The clinical value of multimode dynamic imaging in diagnosing vertebral artery dissection

作　　者：徐锐[1] 王荣华[2] 刘鑫[1] 朱甲峰[1] 赵兴康[1] 

机构地区：[1]济宁医学院附属日照市人民医院,山东日照276800 [2]日照职业技术学院,日照276800

出　　处：《济宁医学院学报》2015年第4期258-260,263,共4页Journal of Jining Medical University

基　　金：2013年济宁医学院重点项目(编号:JY2013KJ 050)

摘　　要：目的探讨多模式动态影像学诊断椎动脉夹层的临床价值及对治疗的指导意义。方法经多模式动态影像学检查确诊的25例椎动脉夹层患者,其中8例经动态影像学检查观察夹层演变情况。结果颅外段椎动脉夹层MR表现为"新月形"壁内血肿,颅内段MR表现为瘤样扩张伴血栓形成。颅外段椎动脉夹层CT血管造影(CTA)表现为内膜瓣和动脉双腔,颅内段CTA表现为瘤样扩张伴腔内血栓及钙化。颅外段椎动脉夹层数字减影血管造影(DSA)表现为动脉狭窄、双腔、内膜瓣,颅内段DSA表现为"珠线征"。3例蛛网膜下腔出血(SAH)患者经动态DSA检查确诊颅内段椎动脉夹层。5例颅外段椎动脉夹层患者行动态DSA观察夹层演变,4例自愈,1例因病变进展行介入治疗。结论多模动态影像学检查可提高椎动脉夹层的早期确诊率,并能动态观察椎动脉夹层演变过程,对临床治疗具有重要的指导意义。Objective To explore the clinical value of multimode dynamic imaging in diagnosing and treating ver- tebral artery dissection. Methods A total of 25 patients were diagnosed vertebral artery dissections by multimode dynamic imaging, 8 patients of all were diagnosed by dynamic imaging to observe the evolution of dissections. Results The MR feature of extracranial dissection was crescentic shape intramural hematoma, while the intracranial dis- section was aneurysmal dilatation. The CTA feature of extracranial dissection was intimal flap or a double lumen, while the intracranial dissection was aneurysmal dilatation with thrombus and calcification. The DSA feature of ex- tracranial dissection was artery stenosis, intimal flap or a double lumen, while the intracranial dissection was ＂pearl and string sign＂. 3 cases of SAH patients were diagnosed as vertebral artery dissections by the dynamic imaging. 5 patients with extracranial dissections were given dynamic imaging to observe the evolution. 4 of them were healed spontaneously, the other one was performed stent placement because of the dissection progressed. Conclusion Mul- timode dynamic imaging can improve the diagnosis rate of vertebral artery dissection,and can help to obtain more detailed diagnostic information and observe the evolution of vertebral artery dissections. It has an important guiding significance in making clinical treatment strateeies.

关 键 词：椎动脉夹层 多模式 动态 影像诊断 

分 类 号：R816.1[医药卫生—放射医学]