高分辨MRI判断椎动脉颅内终末段发育纤细与动脉粥样硬化性病变  

High-resolution MRI identifying the terminal segment of the intracranial vertebral artery fine and atherosclerotic lesions

作　　者：高鹏[1] 马妍[2] 段祥攻 王亚冰[2] 谌燕飞[2] 朱凤水[1] 焦力群[1] 

机构地区：[1]首都医科大学宣武医院神经介入放射科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053 [3]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》2017年第4期197-202,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家十二五科技支撑计划(2011BAI08B04);国家"十三五"重点研发计划(2016YFC1301700);北京市科技新星计划(2010B052)

摘　　要：目的采用高分辨MRI(HRMRI)技术评价椎动脉颅内终末段(tICVA)发育纤细与动脉粥样硬化性病变,以指导血管内介入治疗。方法回顾性分析2015年10月至2016年10月,首都医科大学宣武医院收治的4例经DSA诊断双侧tICVA纤细患者。同时采用HRMRI的时间飞跃法和黑血技术,分析4例患者双侧tICVA影像特征,鉴别动脉先天性发育不良与动脉粥样硬化性病变。结果 DSA显示4例患者双侧tICVA纤细或闭塞,经HRMRI评价血管壁结构显示,4例患者椎动脉发育不良均位于右侧,表现为管壁厚度无明显增厚,直径小于对侧的1/2;左侧为动脉粥样硬化性狭窄1例,闭塞3例,表现为局部管壁的增厚、斑块的形成,造成相应管腔的缩小甚至闭塞。对其中3例行血管内介入治疗。结论 HRMRI有助于鉴别椎动脉终末段发育不良与动脉粥样硬化狭窄或闭塞,判断椎动脉的优势侧,为椎动脉的血管内介入治疗提供影像依据。Objective To evaluate the terminal segment of the intracranial vertebral artery （tICVA） fine and atherosclerotic lesions using high-resolution MRI （HRMRI） in order to guide endovascular interventional therapy.Methods From October 2015 to October 2016,4 patients with bilateral tICVA diagnosed with digital subtraction angiography （DSA） and admitted to Xuanwu Hospital,Capital Medical University were analyzed retrospectively.At the same time,time of flight （TOF） and black blood imaging were used.The bilateral tICVA imaging features in 4 patients were analyzed.Congenital dysplasia of vertebral artery and atherosclerotic lesions were identified.Results DSA revealed that bilateral tICVA fine or occlusion.HRMRI evaluation of the vascular wall structure showed that vascular dysplasia in 4 cases were all located on the right sides,showing no obvious thickening of the wall thickness,and the diameter was less than 1/2 of the contralateral side.One patient had atherosclerotic stenosis on the left and 3 had occlusion,showing local wall thickening,plaque formation,and resulting in the narrowing of the corresponding lumen and even occlusion.Three of the patients were treated with endovascular intervention.Conclusion HRMRI is helpful to differentiate hypoplasia in terminal intracranial vertebral artery and atherosclerotic stenosis or occlusion,identifying the dominant side of the vertebral artery and providing image basis for endovascular treatment of vertebral artery.

关 键 词：动脉粥样硬化狭窄 椎动脉颅内终末段发育不良 高分辨磁共振成像 鉴别诊断 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]