高原地区正常成人脑血管侧支CTA评价  

CTA Evaluation of Cerebrovascular Collaterals in Normal Adults at HighAltitude

作　　者：胡惠莹 鲍海华[1] 康东杰 HU Huiying;BAO Haihua;KANG Dongjie(Department of Medical Imaging Center,the Affiliated Hospital of Qinghai University,Xining,Qinghai Province 810001,P.R.China)

机构地区：[1]青海大学附属医院影像中心

出　　处：《临床放射学杂志》2019年第10期1948-1951,共4页Journal of Clinical Radiology

基　　金：国家自然科学基金资助项目(编号:81060177);青海省科技厅计划项目(编号:2017-SF-158)

摘　　要：目的利用CT血管造影(CTA)观测世居高原低氧环境的正常成人Willis环形态,为高原脑血管的变异提供参考。方法回顾性搜集6年来高原(海拔2500~3500米及以上)地区头颅影像未见明显异常,并行头颅CTA检查的成人共536例,将其分为3组(2500~3000米,3100~3500米,3500以上),利用后处理技术得到图像(VR、MIP),组间计数资料的比较采取卡方检验。结果 536例随机样本,根据国际分型标准分为4型,Ⅰ型结构为14.9%(80例),Ⅱ型结构为10.8%(58例),Ⅲ型结构为50.2%(269例),Ⅳ型结构为24.1%(129例);再根据实际病例新增亚型,前循环发育有3个亚型:Ⅱa为1.7%(9例),Ⅱb为3.4%(18例),Ⅱc为5.2%(28例),Ⅱd为0.6%(3例);后循环变异分5个亚型:Ⅲa为18.3%(98例),Ⅲb为14.0%(75例),Ⅲc为12.3%(66例),Ⅲd为4.9%(26例),Ⅲe为0.7%(4例);前、后循环变异情况分为5个亚型:Ⅳa为17.4%(93例),Ⅳb型为2.6%(14例),Ⅳc型为1.9%(10例),Ⅳd型为2.2%(12例),Ⅳe型结构为3.5%(19例)。Ⅲ型(后循环发育异常)检出率最高,其中Ⅲa (单侧后交通发育异常)检出率高;海拔3500米以上完整Willis环较海拔2500~3000米更高,差异具有统计学意义(P=0.013,0.05)。大脑前动脉A1段发育不良和A1段缺如常伴有同侧大脑后动脉段的增粗(P=0.044,0.05);且大脑动脉环发育男女差异无统计学意义(P=0.203,0.05)。结论高原地区Willis环完整率低,以后循环发育异常为主;海拔高度的变化会对Willis环的变异类型造成影响,低氧环境在一定程度上能促进后交通动脉开放,进行适应性代偿。Objective CT angiography(CTA) was used to observe the morphology of normal adult Circle of Willis in the low-oxygen environment of the plateau,which provided a reference for the variation of plateau cerebral vessels. Methods This study retrospectively collected 536 adult heads with no abnormalities in the plateau(2500-3500 m and above) in the past six years,and divided them into three groups(2500-3000 m,3100-3500 m,3500 or more),using post-processing techniques to obtain images(VR,MIP). The chi-square test was performed on the comparison of the obtained inter-group count data to obtain statistical data. Results 536 random samples were classified into 4 types according to international classification criteria,14.9%(80 cases) for type Ⅰ structures,10.8%(58 cases) for type Ⅱ structures,and 50.1%(269 cases) for type Ⅲ structures;Ⅳ 24.1%(129 cases).Subtypes were added according to actual cases.3 subtypes were recorded in the pre-circulation development:0.9%(9 cases) for Ⅱa;3.4%(18 cases) for Ⅱb;5.2% for Ⅱc( 28 cases) Ⅱd was 0.6%(3 cases). Post-circulation variation was divided into 5 subtypes,Ⅲa was 18.3%(98 cases),Ⅲb was 14.0%(75 cases),Ⅲc was 12.3%(66 cases),Ⅲd For 4.9%(26 cases) and Ⅲe for 0.75%(4 cases),the pre-and post-cycle variability was divided into 5 subtypes:Ⅳa was 17.4%(93 cases);Ⅳb type structure was 2.6%(14 cases);Ⅳc was 1.9%(10 cases);Ⅳd type was 2.2%(12 cases);Ⅳe type was 3.5%(19 cases). Type Ⅲ(post-circulation dysplasia) had the highest detection rate;Ⅲa(unilateral posterior dysplasia) has a high detection rate. A1 segment deficiency is more likely to cause ipsilateral PCoA thickening(P=0.044,0.05). Primary collateral circulation development has no obvious gender difference. Altitude affects the detection rate of the complete circle-of-Willis(P=0.013,0.05). Conclusion The integrity rate of circle-of-Willis in plateau is lower than that in low altitude area,and the circulation is abnormal. Altitude changes affect the type of variation of the circle-of-Willis. The

关 键 词：CT血管造影 WILLIS环 高原地区 

分 类 号：R74[医药卫生—神经病学与精神病学]