头颈部夹层动脉瘤致急性脑卒中的CT血管造影特征  

CT Angiography Features of Craniocervical Dissecting Aneurysm in Patients with Acute Stroke

作　　者：张丽萍[1] 唐秉航[1] 何亚奇[1] 李良才[1] 吴任国[1] ZHANG Liping;TANG Binghang;HE Yaqi;LI Liangcai;WU Renguo(Department of CT,Zhongshan City People’s Hospital,Zhongshan 528403,China)

机构地区：[1]中山市人民医院CT室,广东中山528403

出　　处：《中国医学影像学杂志》2020年第4期317-320,共4页Chinese Journal of Medical Imaging

摘　　要：目的总结引起急性脑卒中的头颈部夹层动脉瘤(CDA)的多层螺旋CT血管造影(MSCTA)特征。资料与方法回顾性分析28例行数字减影血管造影(DSA)检查并证实为CDA患者的MSCTA表现,观察夹层“双腔征”、内膜线、瘤样扩张、锥状狭窄/闭塞、“珠线征”的出现率。结果28例CDA患者中,表现为蛛网膜下腔出血15例,其中6例伴脑室出血;表现为急性脑梗死13例。本组CDA患者共发现夹层29处,累及前循环11处、后循环18处,其中1例同时发生在双侧颈内动脉颈段;34.5%(10/29)出现“双腔征”,24.1%(7/29)出现内膜线,58.6%(17/29)出现瘤样扩张,37.9%(11/29)出现锥状狭窄/闭塞,13.8%(4/29)出现“珠线征”。以DSA为“金标准”,MSCTA的诊断敏感度为93.1%、特异度为99.8%、诊断符合率为99.5%。急性出血患者中,13例出现瘤样扩张;急性脑梗死患者中,9例出现病变处血管狭窄、闭塞。结论MSCTA对CDA具有较好的诊断能力。头颈部夹层的影像学表现复杂多样。急性出血患者责任血管多表现为瘤样扩张;急性梗死患者责任血管多表现为狭窄、闭塞。Purpose To summarize the features of multi-slice spiral CT angiography(MSCTA)of craniocervical dissecting aneurysm(CDA)in patients with acute stroke.Materials and Methods Retrospective analysis of 28 cases underwent digital subtraction angiography(DSA)examination and confirmed the MSCTA manifestation of CDA patients.Observed dissection"double lumen",intimal flap,tumor-like expansion,pyramidal stenosis/occlusion,and the occurrence rate of"pearl line sign".Results Among the 28 patients with CDA,15 showed subarachnoid hemorrhage,6 of them with intraventricular hemorrhage;13 showed acute cerebral infarction.A total of 29 dissections were found,involving 11 anterior circulation and 18 posterior circulation,of which 1 case occurred at the same time in the cervical segment of the bilateral internal carotid artery;34.5%(10/29)had"double lumen",24.1%(7/29)had an intimal flap,58.6%(17/29)had a tumor-like expansion,37.9%(11/29)had pyramidal stenosis/occlusion,and 13.8%(4/29)had a"pearl line sign".Taking DSA as the"gold standard",the diagnostic sensitivity of MSCTA was 93.1%,the specificity was 99.8%,and the diagnostic coincidence rate was 99.5%.Among patients with acute hemorrhage,13 cases had tumor-like expansion;among patients with acute cerebral infarction,9 cases had vessel stenosis and occlusion.Conclusion MSCTA has a good diagnostic ability for CDA.The imaging manifestations of the head and neck dissection are complex and diverse.Responsible vessels in patients with acute hemorrhage mostly showed tumor-like dilation;in patients with acute infarction,most of them show stenosis and occlusion.

关 键 词：动脉瘤 夹层 颅内动脉瘤 颈内动脉夹层 卒中 体层摄影术 螺旋计算机 计算机体层摄影血管造影术 脑血管造影术 

分 类 号：R732.21[医药卫生—肿瘤] R730.42[医药卫生—临床医学]