多模态CT、MRI在症状性非急性大脑中动脉闭塞血管内治疗中的应用价值  

Application Value of Multimodal CT and MRI in Endovascular Treatment of Symptomatic Non-acute Middle Cerebral Artery Occlusion

作　　者：崔焕喜 刘瑞华[1] 崔红凯[1] 裴观辉 李道广 陈松 孙广普 谷世立 李豪 任进发 王明盛[1] CUI Huanxi;LIU Ruihua;CUI Hongkai;PEI Guanhui;LI Daoguang;CHEN Song;SUN Guangpu;GU Shili;LI Hao;Ren Jinfa;WANG Mingsheng(Department of Neurointervention,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院神经介入科,河南新乡453100

出　　处：《河南医学研究》2023年第23期4238-4242,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220604)。

摘　　要：目的探讨术前应用多模态CT[头颈部CT血管成像(CTA)+脑部计算机断层扫描灌注成像(CTP)]和多模态MRI[头颅MRI平扫+高分辨MRI(HRMRI)]评估在症状性非急性大脑中动脉闭塞血管内治疗中的应用价值。方法回顾性分析2020年5月至2022年7月新乡医学院第一附属医院神经介入病房收治的17例症状性非急性大脑中动脉闭塞患者的临床资料及血管内治疗结果。17例患者术前行头颈部CTA评估血管通路和侧支循环状况。采用脑CTP评价脑组织灌注状态;头颅MRI平扫评估核心梗死的大小;HRMRI识别血管闭塞的病因、长度、斑块稳定性或斑块成分、推测闭塞时间及远端血管床评估,指导手术方案的制定。手术后脑血管造影改良脑梗死溶栓评分(mTICI)≥2b级的患者血运恢复视为成功。术后24 h行颅脑CT检查,了解颅脑状况。1周内行影像学检查(MRI平扫、MRA或CTA),评估是否有新发脑梗死、出血及血管是否通畅及再狭窄。术后90 d门诊随访改良Rankin量表评分≤2分为预后良好。术后6~12个月脑动脉CTA或数字减影血管造影(DSA)评估血管情况。结果17例患者均成功开通闭塞血管,其中球囊扩张4例,球囊扩张+支架植入术13例。支架贴壁良好,血流通畅。1例(5.8%)新发脑梗死,术后90 d随访17例患者中15例(88.2%)预后良好,无神经系统症状加重。15例患者术后6~12个月完成影像学随访(14例血管完全通畅,1例单纯球囊扩张后出现中度狭窄)。结论多模态CT和MRI对评价大脑中动脉闭塞的血管通路、侧支循环、脑组织灌注、核心梗死、病因、闭塞长度、闭塞时间及远端血管床具有较高的诊断价值,有利于提高症状性大脑中动脉闭塞血管内治疗的安全性和有效性。Objective To evaluate the preoperative application of multimodal CT[head and neck CT angiography(CTA)+brain computed tomography perfusion(CTP)]and multimodal MRI[head MRI plain scan+high resolution MRI(HRMRI)]in the intravascular treatment of symptomatic non-acute middle cerebral artery occlusion.Methods The clinical data and endovascular treatment results of 17 patients with symptomatic non-acute middle cerebral artery occlusion admitted to the neurointerventional ward of the First Affiliated Hospital of Xinxiang Medical College from May 2020 to July 2022 were retrospectively analyzed.Seventeen patients underwent head and neck CTA before surgery to evaluate vascular access and collateral circulation.Cerebral CTP was used to evaluate the perfusion status of brain tissue.Head MRI plain scan was used to evaluate the size of the core infarction.HRMRI identifies the cause,length,plaque stability or plaque composition of vascular occlusion,predicts the occlusion time and evaluates the distal vascular bed to guide the formulation of surgical protocols.After surgery,cerebral angiography improved the recovery of blood flow in patients with modified thrombolysis in cerebral infarction scale(mTICI)≥2b level.Craniocerebral CT examination was performed 24 hours after operation to understand the craniocerebral condition.Imaging examination(MRI plain scan,MRA or CTA)was performed within one week to assess whether there was a new cerebral infarction,bleeding,and whether the blood vessels were patency and restenosis.After 90 days of postoperative outpatient follow-up modified Rankin scale score≤2 was classified as good prognosis.Cerebral artery CTA or DSA were used to evaluate the vascular condition 6 to 12 months after surgery.Results The occlusive vessels were successfully opened in all the 17 patients,including balloon dilation in 4 cases and balloon dilation+stent implantation in 13 cases.The stent adhered well to the wall and the blood flow was unobstructed.One patient(5.8%)had a new cerebral infarction,and 15(88.2%)of

关 键 词：多模态CT 多模态MRI 症状性非急性大脑中动脉闭塞 血管内治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]