颈内动脉缺如超声诊断要点及其他影像学特点分析  

The utilization of carotid artery ultrasound in diagnosis of internal carotid artery absence and its imaging features

作　　者：程盼 刘保龙[1] 赵碧波[2] 于德林[1] CHENG Pan;LIU Bao-long;ZHAO Bi-bo;YU De-lin(Department of Ultrasound Diagnosis,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Medical Imaging,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院超声科,300350 [2]天津市环湖医院影像科,300350

出　　处：《中国现代神经疾病杂志》2023年第10期933-939,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的总结颈内动脉缺如的超声诊断要点及其他影像学特征。方法与结果选择天津市环湖医院2014年1月至2023年5月明确诊断的14例颈内动脉缺如患者。CTA和(或)MRA均表现为颈动脉管缺失,颈内动脉全程不显影伴有颅内血管发育异常;颈内动脉缺如位于左侧8例,右侧5例,双侧1例;颅内侧支循环代偿LIE分型6例为A型,2例与A型略有不同(缺如侧大脑前动脉A1段存在),2例为B型,1例为C型,1例与D型略有不同(缺如侧大脑前动脉经前交通动脉由对侧大脑前动脉供血,缺如侧大脑中动脉由对侧颈内动脉床突段发出分支供血)。颈动脉超声均可见颈总动脉颅外段纤细且未见分叉,直接延续为颈外动脉,提示单侧或双侧颈内动脉缺如;颈动脉超声二维结构及彩色血流全程多角度扫描均未探及颈动脉分叉,颈总动脉直接延续为单一颈外动脉并可见多个分支;颞浅动脉叩击试验可见血流频谱舒张期呈“锯齿”样改变,提示为颈外动脉;缺如侧颈总动脉与颈外动脉血流频谱形态具有一致性。结论颈内动脉缺如经颈动脉超声初步诊断的准确性较高,适于临床推广应用。Objective To explore diagnosis points of carotid artery ultrosound in patients of internal carotid artery(ICA)absence and other imaging features.Methods and Results Total 14 patients diagnosed with ICA absence in Tianjin Huanhu Hospital from January 2014 to May 2023 were retrospectively analyzed.Ten patients were male and 4 patients were female.The age of patients ranged from 13 to 79 years.Imaging exam:the CTA and(or)MRA of all patients showed absence of carotid canal,no development of the entire ICA,combined with intracranial vascular abnormalities.Eight of 14 patients had left ICA absence,5 had right ICA absence,and one had bilateral ICA absence.According to collateral compensation LIE typing,6 cases were type A,2 cases were similar to type A with the existent of the A1 segment of ipsilateral anterior cerebral artery(ACA),2 cases were type B,one case was type C,and one case was similar to type D as ipsilateral ACA was supplied by opposite through the anterior communicating artery,the ipsilateral middle cerebral artery(MCA)was supplied from the clinoid process of the contralateral ICA.Carotid artery ultrasound:all the 14 patients showed thin vessels in the extracranial segment of the common carotid artery(CCA)without bifurcation,which directly continued into external carotid artery(ECA),indicating the absence of one or both ICA absence;carotid artery bifurcation was not detected in multi⁃angle scanning of both 2D scan and color Doppler flow imaging,and the CCA directly continued into a single artery ECA with multiple branches;a"sawtooth"spectrum of the ipsilateral ECA was observed when tap the superficial temporal artery,which indicated that the artery was ECA;blood flow spectrum of the ipsilateral CCA was consistent with ipsilateral ECA.Conclusions Carotid artery ultrasound has high accuracy in the initial diagnosis of ICA absence.It is suitable for clinical application.

关 键 词：颈内动脉 先天畸形 超声检查 计算机体层摄影血管造影术 

分 类 号：R743[医药卫生—神经病学与精神病学]