致缺血性卒中颅内动脉夹层的MRI评估价值  

Assessments of intracranial arterial dissection causing ischemic stroke with magnetic resonance imaging

作　　者：李竹浩[1] 陈红兵[2] 曾进胜[2] 洪华[2] 刘刚[2] 张爱武[2] 张健[2] 罗柏宁[1] 

机构地区：[1]中山大学附属第一医院放射科,广州510080 [2]中山大学附属第一医院神经内科,广州510080

出　　处：《中国脑血管病杂志》2015年第11期587-593,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：广东省医学科研基金项目(B2012083)

摘　　要：目的探讨常规MRI、MR血管成像(MRA)和高分辨MRI诊断致缺血性卒中的颅内动脉夹层(IAD)的价值。方法前瞻性连续纳入59例于2008年8月至2015年4月在中山大学附属第一医院神经科住院的IAD致缺血性卒中患者[年龄(45±15)岁,男41例]。所有患者接受常规头部MRI/MRA检查,对其中25例行全脑DSA检查,对10例行高分辨MRI。分析IAD的常规MRI/MRA和高分辨MRI表现。对行DSA的患者,比较DSA与常规MRI/MRA对典型夹层征象的检出及符合率。结果 (1)59例中,常规MRI/MRA检测到42例(71.2%)典型夹层征象,其中以壁内血肿(52.4%,22例)最常见,其他征象包括内膜征/双腔征(31.0%,13例)和长段不规则或丝线样狭窄(21.4%,9例);而夹层动脉瘤(16.7%,7例)和鼠尾状闭塞(7.1%,3例)相对少见;常规MRI/MRA未检测到典型夹层征象的17例(28.8%)IAD中,夹层累及大脑中动脉(64.7%,11/17)较常规MRI/MRA检测到典型夹层征象的42例IAD(23.8%,10/42)更为多见,差异有统计学意义(χ2=11.325,P=0.006)。(2)25例接受DSA检查的患者中,15例(60.0%)有典型夹层征象;而常规MRI/MRA仅检测到其中8例(32.0%)有典型夹层征象,但差异无统计学意义(P=0.088)。(3)有10例(16.9%)IAD常规MRI/MRA和DSA均显示非特异性局限性狭窄或截断样闭塞,而高分辨MRI检测到其中5例有内膜征,4例有壁内血肿,1例有内膜征和壁内血肿。结论常规头部MRI/MRA是检测IAD的有效技术,而高分辨MRI在诊断其他血管影像学检查无典型夹层表现的IAD方面独具优势。Objective To investigate the values of conventional magnetic resonance imaging（ MRI）,magnetic resonance angiography（ MRA）,and high-resolution MRI for diagnosing intracranial arterial dissection（ IAD） caused ischemic stroke. Methods From August 2008 to April 2015,59 consecutive patients（ age 45 ± 15 years,41 males） with IAD caused ischemic stroke admitted to the First Affiliated Hospital of Sun Yat-Sen University were enrolled prospectively. All patients underwent conventional cranial MRI /MRA examination,25 of them underwent whole brain DSA examination,and 10 underwent high-resolution MRI.The findings of conventional MRI / MRA and high-resolution MRI of IAD were analyzed. For patients undergoing DSA,the proportions of detection and compliance of IAD were compared between DSA and conventional MRI / MRA. Results（ 1） Conventional MRI / MRA revealed typical sign of artery dissection in 42patients（ 71. 2 %）,among them,the intramural hematoma（ n = 22,52. 4 %） was most common. Other common signs included intimal flap / double lumen sign（ n = 13,31. 0%） and long irregular or thread-like stenosis（ n = 9,21. 4%）; while dissecting aneurysm（ n = 7,16. 7%） and rat tail-shaped occlusion（ n = 3,7. 1%） were relatively rare. In 17 patients（ 28. 8%） with IAD that conventional MRI / MRA did not detect the typical dissection sign,the dissections were involved in the middle cerebral artery（ 11 /17,64. 7%）,they were more common than the 42 patients with IAD（ 10 /42,23. 8%） detected the typical dissection sign by conventional MRI / MRA. There was significant difference（ P = 0. 006）.（ 2） Among the 25 patients undergoing DSA,DSA revealed that 15 patients（ 60%） had the typical dissection sign,and conventional MRI / MRA only revealed 8 of them（ 32%） with the typical dissection sign,but there was no significant difference（ P = 0. 088）. In 15 patients with IAD that DSA detected the typical dissection sign; conventional MRI / MRA detected the typical dissection sign

关 键 词：颅内动脉夹层 缺血性卒中 血管造影 数字减影 磁共振成像 磁共振血管成像 高分辨磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]