颈动脉一过性血管周围炎综合征的影像学诊断研究进展  

Advances in imaging diagnosis of transient perivascular inflammation of the carotid artery

作　　者：史宛瑞 崔立刚[1] Shi Wanrui;Cui Ligang(Department of Ultrasound,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院超声科,100191

出　　处：《中华脑血管病杂志（电子版）》2024年第5期516-519,共4页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

摘　　要：颈动脉一过性血管周围炎综合征(TIPIC)是一种临床罕见疾病,主要表现为颈部疼痛,多为单侧、钝痛,程度不一,可累及颈部外侧以及颈动脉分叉处。该病的发病机制尚不清楚,可能为非特异性炎症。影像学检查是TIPIC诊断的主要依据,主要包括血管壁以及血管周围的表现,前者主要指影响血管壁本身的表现,后者主要指血管周围的局部浸润,表现为不规则的软组织取代血管周围的脂肪组织,多发生在颈动脉分叉处的后部或外侧。该病的超声表现为血管周围的异常低回声软组织呈“洋葱皮”特征表现和血管内膜的低回声斑块,管壁可呈偏心增厚,但无明显的管腔狭窄或者轻度狭窄,血流动力学未见明显改变;增强检查可见低回声软组织病变内存在微泡灌注增强表现。磁共振成像主要表现为病变周围软组织增厚,增强成像后血管周围浸润的软组织对比度显著增强。该病CT主要表现为血管周围软组织出现薄而规则的低密度增厚,没有明显的血管狭窄。正电子发射断层扫描显示病变处摄取增高。TIPIC具有自限性,多在发病2周内消退。本文就TIPIC的影像学诊断展开综述。Transient perivascular inflammation of the carotid artery(TIPIC)is a rare clinical entity characterized by neck pain,typically described as a dull ache,and is often unilateral with variable intensity.This pain can be localized to the lateral neck area and the carotid artery bifurcation.The mechanism of TIPIC is still unclear,possibly due to non-specific inflammation.Imaging examinations are pivotal for diagnosing TIPIC,mainly including the appearance of the vascular wall and the surrounding area.The former mainly refers to the manifestations that affect the blood vessel wall itself.The latter mainly refers to the local infiltration around blood vessels,manifested as irregular soft tissue replacing the adipose tissue around the blood vessels,and mostly occurs at the posterior or lateral part of the bifurcation of the carotid artery.Sonographically,TIPIC is characterized by an"onion-skin"pattern of abnormal hypoechoic soft tissue surrounding the vessels and hypoechoic plaques on the vascular intima.The vascular wall can be eccentrically thickened,but there is typically no significant luminal narrowing or only a mild reduction without hemodynamic impact.Contrast-enhanced imaging reveals the presence of microbubble perfusion enhancement in low echogenic soft tissue lesions.MRI shows a marked perivascular thickening.MRI with contrast shows the enhancement of the perivascular tissue.CT shows a thin,regular hypodense wall thickening,without significant stenosis.Fluorodeoxyglucose positron emission tomography depicts a significant focal uptake surrounding perivascular changes.TIPIC may resolve spontaneously,typically within two weeks.This article reviews the imaging diagnosis of TIPIC.

关 键 词：颈动脉一过性血管周围炎综合征 颈动脉痛 超声 超声造影 

分 类 号：R74[医药卫生—神经病学与精神病学]