高分辨率磁共振诊断椎动脉夹层的影像学特征分析  

Analysis of imaging features of high-resolution magnetic resonance in the diagnosis of vertebral artery dissection

作　　者：王彦平[1] 张保朝[1] 闻公灵[1] 刘义锋[1] 汪宁[1] 孙军[1] 茹睿 温昌明[1] WANG Yanping;ZHANG Baochao;WEN Gongling;LIU Yifeng;WANG Ning;SUN Jun;RU Rui;WEN Changming(Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院,河南南阳473000

出　　处：《中国实用神经疾病杂志》2020年第23期2044-2049,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省2019年科技发展计划项目(编号:192102310349)。

摘　　要：目的探讨高分辨率磁共振成像(HRMRI)在诊断椎动脉夹层(VAD)中的临床特征,以及不同影像方法对VAD诊断的差异。方法回顾分析2014-03—2019-11南阳市中心医院14例经HRMRI诊断的VAD患者,观察VAD在HRMRI中的临床特征,分析彩色多普勒超声(CDU)、经颅多普勒超声(TCD)、CT血管造影术(CTA)等不同影像方法诊断VAD的差异。结果14例患者中HRMRI发现16支VAD,影像表现为壁内血肿、双腔征、内膜瓣;颅外段VAD 8例,经CDU诊断7例,阳性率85.70%,表现为双腔型、壁内血肿型、瘤样扩张;颅内段VAD 6例,TCD检查表现为血流频谱呈高阻型改变;CTA诊断4例,阳性率28.57%,表现为双腔症、内膜瓣、血管腔呈偏心性狭窄或闭塞、动脉瘤。结论HRMRI诊断VAD清晰易辨,对血管壁及壁内成分可清晰显示,已成为诊断VAD的重要手段。CDU可作为颅外段VAD首选的筛查手段;对TCD、CTA检查发现性质难定的血管异常患者,选择HRMRI检查,可提高VAD的诊断率。Objective To investigate the clinical features of high resolution magnetic resonance imaging(HRMRI)in the diagnosis of vertebral artery dissection(VAD),and analysis of different imaging methods in the diagnosis of VAD.Methods 14 cases of vertebral artery dissection in patients were diagnosised by HRMRI from March 2014 to November 2019,Observe the clinical features of VAD in HRMRI,and analyze the differences in diagnosis of VAD by different imaging methods such as color Doppler ultrasound(CDU),transcranial Doppler ultrasound(TCD),CT angiography(CTA).Results Among the 14 patients,16 VADs were found on HRMRI,and the images showed intramural hematoma,double-chamber sign,and intimal flap;8 cases of extracranial VAD,7 cases were diagnosed by CDU,and the positive rate was 85.70%.Internal hematoma type,tumor-like expansion;6 cases of intracranial VAD,TCD examination showed high-resistance changes in blood flow spectrum;4 cases were diagnosed by CTA,the positive rate was 28.57%,manifested as double-chamber disease,intimal flap,vascular cavity eccentric stenosis or occlusion,aneurysm.Conclusion The diagnosis of VAD by HRMRI is clear and easy to distinguish,and the blood vessel wall and the components in the wall can be clearly displayed,which has become an important means of diagnosing VAD.CDU can be used as the preferred screening method for extracranial VAD.For patients with abnormal blood vessels found by TCD and CTA,HRMRI can improve the diagnosis rate of VAD.

关 键 词：椎动脉夹层 高分辨率磁共振成像 彩色多普勒超声 经颅多普勒超声 CT血管造影术 

分 类 号：R743.9[医药卫生—神经病学与精神病学]