影像学上动脉瘤样的大脑中动脉分支闭塞的临床分析  

Clinical Analysis of Aneurysmal Middle Cerebral Artery Branch Occlusion

作　　者：陈建才 王豪杰 李春旺 蔡嘉伟 王灯亮[2,3] 林元相 林福鑫[2,3,4] 康德智 CHEN Jiancai;WANG Haojie;LI Chunwang;CAI Jiawei;WANG Dengliang;LIN Yuanxiang;LIN Fuxin;KANG Dezhi(Department of Neurosurgery,Anxi County Hospital,Quanzhou City,Quanzhou 362400,China;Department of Neurosurgery,Neurosurgery Research Institute,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Fujian Clinical Research Center for Neurological Disease,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Clinical Research and Translation Center,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Fujian Institute for Brain Disorders and Brain Science,Fuzhou 350005,China)

机构地区：[1]泉州市安溪县医院神经外科,泉州362400 [2]福建医科大学附属第一医院神经外科,福建医科大学神经外科研究所,福州350005 [3]福建省神经系统疾病临床医学研究中心,福州350005 [4]福建医科大学附属第一医院临床研究与转化中心,福州350005 [5]福建省脑重大疾病与脑科学研究院,福州350005

出　　处：《福建医科大学学报》2021年第6期492-497,共6页Journal of Fujian Medical University

基　　金：国家卫生计生委脑卒中防治工程“中国脑卒中高危人群干预适宜技术研究及推广项目”(GN-2018R002)。

摘　　要：目的探索可用于辨别影像学上动脉瘤样大脑中动脉(MCA)分支闭塞与MCA分叉部动脉瘤的特征。方法收集3例影像学上表现为动脉瘤样的MCA分支闭塞患者的临床资料,回顾同期20例MCA小动脉瘤(直径≤5 mm)患者的临床资料。回顾5例Pubmed文献数据库上影像学表现为动脉瘤样MCA分支闭塞患者的临床资料。比较动脉瘤样MCA分支闭塞和MCA分叉部小动脉瘤临床资料和影像学特征,包括MCA分支数量、动脉瘤外观(圆锥状、柱状和囊状)、动脉瘤高(Ha)、动脉瘤宽(Wa)、动脉瘤颈宽(Wn)、动脉瘤水平分支最大宽度(Wb)、是否合并烟雾血管和动脉瘤比例参数(Ha/Wa>1、Wa/Wn≤1和Wa/Wb≤1)。结果 t检验和Fisher检验结果显示,两组间圆锥状(P=0.015)、囊状(P=0.011)、Wa/Wn≤1(P=0.011)、Wa/Wb≤1(P=0.022)的差别具有统计学意义。logistic多因素分析结果显示,圆锥形状(P=0.046)和Wa/Wb≤1(P=0.031)为MCA分支闭塞与MCA分叉部动脉瘤相关的特征。结论诊断MCA分叉部动脉瘤时,若动脉瘤为圆锥状且宽小于相同水平分支最大宽度时,应考虑MCA闭塞的可能性。可通过高分辨率磁共振进一步明确诊断。Objective The aim of this study was to explore reliable features that can be used to differentiate the stump of occluded middle cerebral artery(MCA) branch from real MCA branch aneurysms, and to propose same warning notes. Method This study reported 3 patients with MCA branch occlusion mimicking an bifurcation aneurysm. Then, we reviewed the literature and described the characteristics of all pooled MCA branch occlusion patients. The pooled MCA branch occlusion patients were compared with real small MCA aneurysms(≤5 mm) diagnosed at the same period of that 3 cases reported in this study. The clinical and radiological information, including branch number of MCA, aneurysm appearance(conic, columnar and saccular), height of the aneurysm(Ha), width of the aneurysm(Wa), width of the aneurysm neck(Wn), width of the largest branch of MAC at the same level of protruding lesion(Wb), moyamoya vessels, ratio of aneurysm parameters(Ha/Wa>1, Wa/Wn≤1 and Wa/Wb≤1) were retrieved and compared. Results According to the t test and Fisher test, conic shape(P=0.015), saccular shape(P=0.011) Wa/Wn≤1(P=0.011), Wa/Wb≤1(P=0.022), were significantly associated with artery occlusion. However, the results of multivariate analysis showed that only conic shape(P=0.046) and Wa/Wb≤1(P=0.031) were the independent features related with MCA major branch occlusion. Conclusions In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered when the lesion is conic shape and with a diameter smaller than the largest opening branch at the same level. High resolution magnetic resonance imaging may be needed for differential diagnosis.

关 键 词：大脑中动脉 动脉闭塞 大脑中动脉动脉瘤 神经影像学 

分 类 号：R743[医药卫生—神经病学与精神病学]