头颈CT血管造影联合磁敏感加权成像在小脑后下动脉供血区急性脑梗死责任血管判断中的价值分析  

Value analysis of head and neck CTA combined with susceptibility-weighted imaging in assessing the vessels responsible for acute cerebral infarction in the blood supply area of posterior inferior cerebellar artery territory

作　　者：乔鹏岗 孙如镜 张诗雨 程旭 杨正汉[1] Qiao Penggang;Sun Rujing;Zhang Shiyu;Cheng Xu;Yang Zhenghan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,100050

出　　处：《北京医学》2024年第2期97-102,106,共7页Beijing Medical Journal

基　　金：国家自然科学基金(81701663);北京市医院管理局临床医学发展专项——“扬帆”计划(ZYLX202101);北京市重大疫情防治重点专科项目(京卫医[2021]135号)。

摘　　要：目的 探讨头颈CT血管造影(computed tomography angiography, CTA)联合磁敏感加权成像(susceptibilityweighted imaging, SWI)在小脑后下动脉(posterior inferior cerebellar artery, PICA)供血区急性脑梗死责任血管病变检出中的价值。方法 选取2021年8月至2022年10月首都医科大学附属北京友谊医院PICA供血区急性脑梗死患者50例,诊疗期间接受MRI常规平扫+SWI及头颈CTA检查。按梗死大小分为区域性梗死(37例)和小梗死(13例),基于头颈CTA及SWI观察责任血管改变;头颈CTA观察梗死侧责任血管有无斑块及狭窄,头颈CTA联合SWI观察梗死侧责任血管有无磁敏感血管征(susceptibility vessel sign, SVS);比较头颈CTA及头颈CTA联合SWI对不同类型PICA供血区急性脑梗死患者责任血管病变的检出率。结果 50例患者中,男40例,女10例,年龄43~79岁,中位年龄62.5岁。37例区域性梗死患者中,针对梗死侧椎动脉V4段,头颈CTA检出13例管腔重度狭窄/闭塞,头颈CTA联合SWI其中4例SVS阳性;针对梗死侧PICA,头颈CTA共检出12例管腔重度狭窄/闭塞,头颈CTA联合SWI 12例SVS均为阳性,另检出9例PICA SVS阳性患者。13例小梗死患者中,针对梗死侧椎动脉V4段,头颈CTA检出6例管腔病变,头颈CTA联合SWI其中4例SVS阳性;针对梗死侧PICA,头颈CTA检出6例管腔病变,头颈CTA联合SWI其中5例SVS阳性,另检出1例PICA SVS阳性患者。结论 头颈CTA联合SWI有助于提高PICA供血区急性脑梗死患者责任血管病变的检出率,椎动脉V4段狭窄时帮助判断有无血栓形成及血栓形成位置,有助于提高PICA病变尤其是椎动脉V4段无异常改变时PICA病变的检出率。Objective To explore the value of head and neck computed tomography angiography(CTA)combined with susceptibility-weighted imaging(SWI)in assessing the vessels responsible for acute cerebral infarction in the posterior inferior cerebellar artery(PICA)territory.Methods A total of 50 patients with acute cerebellar infarction in the blood supply area of PICA in Beijing Friendship Hospital,Capital Medical University from August 2021 to October 2022 were selected,and were examined by conventional MRI plain scan+SWI and CTA in the head and neck during diagnosis and treatment,were divided into regional infarction(37 cases)and small infarction(13 cases)based on the size of infarction.Head and neck CTA and SWI were used to evaluate the changes of responsible vessels.CTA was used to observe plaques and stenosis in the responsible vessels on the infarction side,and CTA combined with SWI was used to observe susceptibility vessel sign(SVS)in the responsible vessels on the infarction side.The detection rates of responsible vessel lesions in different types of acute cerebral infarction within the territory of PICA were compared by CTA and CTA combined with SWI.Results A total of 50 patients with acute cerebellar infarction in PICA blood supply area were included,there were 40 males and 10 females,aged from 43 to 79 years,with a median age of 62.5 years.Among the 37 patients with regional infarction,for the V4 segment of the vertebral artery,head and neck CTA detected 13 cases of severe stenosis/occlusion,of which four cases were SVS positive by head and neck CTA combined with SWI;for the PICA,head and neck CTA detected 12 cases of severe stenosis/occlusion,and 12 cases of SVS were positive by head and neck CTA combined with SWI.In addition,nine cases of PICA SVS positive were detected.Among the 13 patients with small infarction,for the V4 segment of the vertebral artery,head and neck CTA detected six cases of luminal lesions,of which four cases were SVS positive by head and neck CTA combined with SWI;for the PICA on the infarcte

关 键 词：小脑梗死 小脑后下动脉 磁敏感加权成像 CT血管造影 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]