缺血性脑血管疾病磁共振血流成像

本文采用磁场强度为２．０Ｔ，并利用磁化转移对比技术，在诊断性ＭＲＩ检查同时，对缺血性脑血管疾病（ＩＣＶＤ）患者６０例进行了磁共振血流成像（ＭＲＡ）检查。发现颅内动脉异常信号４９例（８１．６％），其中动脉闭塞４例，动脉狭窄３９例，动脉分支显著减少８例，其它改变者９例。临床表现，ＭＲＩ与ＭＲＡ对比发现，ＭＲＡ不仅是一项无创伤性检查，所提供脑血管病理改变的信息，在ＩＣＶＤ预防，选择治疗以及预后评估方面可能更为重要。     

老年椎基底动脉眩晕的MRI和MRA对比观察

本文从１８７例临床诊断为椎基底动脉供血不足或椎基底动脉系统ＴＩＡ的病例中选择３３例老年病人，对其ＭＲＩ和ＭＲＡ资料进行了分析。头部ＭＲＩ显示６例异常，占１８．２％，除１例小脑出血外，另５例均为梗塞。ＭＲＡ显示１４例异常，占４２．４％，其中１１例显示与临床症状相应的椎基底动脉系统的闭塞或狭窄，３例显示颈内动脉系统的狭窄。可见，椎基底动脉系统的闭塞或狭窄是老年纯眩晕发作的重要原因之一，部分患者还可能存在小脑、脑干等区的梗塞灶或出血灶等。     

磁共振血管成像诊断脑血管疾病

本组５０例脑血管疾病患者的ＭＲＩ和ＭＲＡ检查说明，ＭＲＡ能检出颅内动脉瘤，动静脉畸形，脑动脉塞和狭窄病变。ＭＲ检查联合应用能显著提高单项ＭＲＩ对ＣＶＤ的诊断价值。ＭＡＲ有可能成为颅内血管疾病有效，常用的诊断手段。     

磁共振血管成像诊断脑血管疾病

本组５０例脑血管疾病患者（ＣＶＤ）的ＭＲＩ和ＭＲＡ检查结果说明，ＭＲＡ能检出颅内动脉瘤、动静脉畸形、脑动脉闭塞和狭窄病变。ＭＲ检查联合应用能显著提高单项ＭＲＩ对ＣＶＤ的诊断价值。ＭＲＡ有可能成为颅内血管疾病有效、常用的诊断手段。     

TCD与DSA,MRA,CTA蛛网膜下腔出血中应用对比研究

应用经颅多普勒超声（ＴＣＤ）、数字减影血管造影（ＤＳＡ）、磁共振血管成像（ＭＲＡ）、ＣＴ血管造影（ＣＴＡ）对２４例蛛网膜下腔出血（ＳＡＨ）病人进行了对照研究。通过ＴＣＤ诊断血管痉挛和狭窄性病变１９例（７９％），治疗前后动态观察发现脑底动脉平均流速（Ｖｍ）增高。诊断颅内压增高２例（８．３％）Ｖｍ降低。血管造影等放射影像学检查，发现动脉瘤８例，动脉炎样改变６例，动脉痉挛２例，正常者８例，总异常率为６６．６％。通过超声与放射影像学比较发现，两者可以从不同角度显示脑血管的功能或病理状态。     

磁共振血管成像诊断脑血管疾病(10例MRA和DSA对照)

０例做ＭＲＡ的患者与其中同时做ＤＳＡ（９例）及手术（１例）的患者进行对照分析，５例ＭＲＡ结果与ＤＳＡ一致，包括２例大脑中动脉起始部闭塞，１例大脑中动脉主干狭窄，２例血管畸形。另５例中，１例ＭＲＡ检查结果显示大脑中动脉主干闭塞，但ＤＳＡ仅显示该段动脉狭窄，２例ＭＲＡ显示两侧颈内动脉虹吸部闭塞，ＤＳＡ除有上述发现外，还检出脑底部异常血管网，１例ＭＲＡ显示左侧颈内血流来自前、后交通动脉，ＤＳＡ检查结果为左侧主动脉弓颈总动脉起始部的闭塞，１例ＭＲＡ显示前交通动脉的动脉瘤，瘤腔大小为１．０ｃｍ×０．９ｃｍ，手术中证实为２．０ｃｍ×１．０ｃｍ，部分瘤腔内有血栓样物质充填。本组资料说明ＭＲＡ能较清晰地显示颅内血管畸形、动脉瘤、Ｗｉｌｉｓ动脉环和大动脉的闭塞和狭窄病变，不足之处为（１）ＭＲＡ可因血管闭塞或动脉瘤腔内有血栓样物质不能准确反映瘤腔大小。（２）目前ＭＲＡ仅能检出大动脉及其一、二级分枝。（３）ＭＲＡ显示动脉狭窄可有病变“夸大现象”。     

3D—CTA,MRA和DSA对脑动静脉畸形成像的对照性研究

目的：评价数字减影血管造影（ＤＳＡ）、三维计算机断层扫描血管造影（３Ｄ－ＣＴＡ）和磁共振血管成像技术（ＭＲＡ）对于脑动静脉畸形（ＡＶＭ）甩像的价值。方法 ４３例ＡＶＭ前瞻性对照研究,结果 ３Ｄ－ＣＴＡ阳性率１００％,与ＤＳＡ比较;供血动脉的来源,数目和形态１００％吻合,引流静脉３３例完全吻合（７８．６％）,９例部分吻合（２１．４％）;病灶部位、大小以及深度１００％吻合。ＭＲＡ阳性率９５．８％,１例假阴性（４．２％）。与ＤＳＡ影像比较,供血动脉１７例完全吻合（７０．８％）,６例部分吻合（２５．０％）;引流静脉１４例完全吻合（５８．３％）,９例部分吻合（３７．５％）,病灶部位、大小以及深度９８．５％吻合。结论 ＤＳＡ是脑ＡＶＭ成像的“金标准”。３Ｄ－ＣＴＡ和ＭＲＡ技术的发展为ＡＶＭ影像不诊断提供了高准确性,无创性的     

出血性脑梗死临床与CT、MRI分析

１６例出血性脑梗死（ＨＩ）病人，均经二次ＣＴ或ＭＲＩ检查。１４例均在首次ＣＴ检查发现颅内单发或多发低密度灶，二次ＣＴ或ＭＲＩ检查均显示大面积脑梗死伴出血，按部位分类以大脑中动脉区为最多（１０例，）影学改变可分为血肿型（５例）及非血肿型（１１例），本组中报告ＨＩ患者率较国外为低，所有病例治疗结果表明非血肿型预后较好，治疗中依其病变没情况进行分别治疗是必要的。     

难治性癫痫的MR影像学研究（附50例分析）

用ＭＲＩ和ＣＴ对５０例难治性癫痫患者同时进行ＭＲＩ（０．５Ｔ）、ＣＴ扫描，并进行对照。结果：ＭＲＩ异常４１例（８２％），病灶７０个，多发灶２２例，颞叶异常３０例（７３．１７％）；ＣＴ异常２８例（５６％），病灶３６个，多发灶８例，颞叶异常１６例（５７．１４％），Ｘ２检验Ｐ＜０．０１，两者有显著性差异。但是，确定病灶要用ＭＢＩ、ＳＰＥＣＴ和ＥＥＧ检测综合判断。     

上矢状窦和乙状窦血栓形成的临床和磁共振诊断七例报告

目的分析上矢状窦、乙状窦血栓形成的临床特点、形成原因、磁共振成像及磁共振血管造影对其诊断的价值。方法回顾性分析７例经磁共振检查确诊的硬脑膜静脉窦血栓形成病人的临床资料及影像学特点,其中男２例,女５例,年龄１５～３４岁。病后３～１１天行磁共振检查,主要观察水肿、静脉性梗死或出血、硬脑膜异常强化及静脉窦内异常信号,部分病人复查时可观察到再通。结果硬脑膜静脉窦血栓形成７例皆有明确原因,临床表现多样,主要为亚急性颅内压增高、抽搐、肢体瘫痪或昏迷。ＭＲＩ常规ＳＥ序列Ｔ１、Ｔ２加权示窦内高信号,脑实质水肿或合并出血、梗死,强化后显示闭塞静脉窦附近硬脑膜异常强化;磁共振脑血管造影（ＭＲＡ）的ＰＣ法示静脉窦高血流信号丢失,２例分别于病后２９及３７天复查ＭＲＩ,结果显示再通,硬脑膜异常强化消失。经降颅内压、抗凝,合并炎症者给予抗生素、激素治疗,１例外伤引起者经手术治疗,７例均治愈。结论硬脑膜静脉窦血栓形成是较为少见的脑血管病,且病情重,ＭＲＩ／ＭＲＡ可帮助确诊。早期治疗可明显改善预后。     

Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly – broadening the clinical spectrum of midline defects

BACKGROUND: Duplication of the pituitary stalk, morning glory disc anomaly and moya moya are rare malformations. The combination of these findings may be syndromic and may have an underlying genetic etiology. METHODS: Case report and review of the literature of neurological, ophthalmological, and neuroradiological findings including ophthalmic examination, MRI and MRA. CASE REPORT: A 2 year-old girl presented with reduced visual acuity and roving eye movements since birth. Ophthalmological workup revealed bilateral morning glory disc anomaly. MRI showed duplication of the pituitary stalk and caudal displacement of the floor of the third ventricle. MRA showed narrowing of the supraclinoid internal carotid arteries with focal narrowing of the proximal middle cerebral arteries consistent with early moya moya disease. CONCLUSIONS: Review of the literature of pituitary gland duplication and of the combination of morning glory disc anomaly and moya moya disease revealed only one previously reported case. However, the spectrum of this possibly syndromic presentation may be much broader and include various types of anterior midline defects and may have a common underlying genetic cause.     

25例烟雾病临床影像特点观察

目的探讨烟雾病的临床特征、影像学特点。方法对25例烟雾病患者首发症状、临床表现及影像学结果进行分析。结果烟雾病发病平均年龄较轻,女性多于男性;少儿烟雾病患者以缺血改变为主(87.5%),成年烟雾病患者缺血改变(58.8%)与出血改变(41.2%)相当;临床以头痛、头晕、肢体无力或偏瘫或交替性瘫痪为主要表现,同时可伴失语、智能下降、视力下降、癫痫发作、小舞蹈发作等表现。14例行头CT检查仅示颅内病灶,均未提示烟雾病;25例均行MRI和MRA检查发现颅内病灶,显示颈内动脉虹吸末段和大脑前或中动脉近段狭窄或闭塞,并有脑基底部异常血管网及侧支循环形成,均被诊断为烟雾病。其中9例又行数字减影血管造影术(DSA),结果与其MRA相符。结论头颅MRI和MRA是诊断烟雾病理想的非介入性检查方法。     

烟雾病的诊断与鉴别诊断

目的 评价烟雾病的诊断方法，讨论其鉴别诊断。方法 回顾性分析11例烟雾病的CT、MRI及MRA资料，分析脑实质及脑血管的形态学改变。结果 CT及MRI表现为脑实质改变。脑出血3例，脑梗化6例，脑萎缩2例；MRA均见有不同程度的颈内动脉分叉以上狭窄或闭塞，其中双侧颈内动脉狭窄6例，单侧颈内动脉狭窄5例；大脑中动脉狭窄20支，大脑前动脉狭窄18支，大脑后动脉狭窄14支；9例同时显示异常血管网。结论 烟雾病主要靠放射学诊断，MRA可很好地显示烟雾病异常血管，可作为筛台烟雾病首选方法。诊断时，要排除脑中风、动脉瘤和动静脉畸形出血。     

Moyamoya病的临床表现与影像学特点

目的 回顾分析12例Moyamoya病的临床和影像学特征，探讨Moyamoya病的影像学诊断价值。方法 分析12例Moyamoya病患的临床资料及数字减影血管造影(DSA)、磁共振血管造影(MRA)、磁共振成像(MRI)和CT结果。结果 所有病例均表现有颈内动脉或其分支不同程度的狭窄或闭塞和颅底异常血管网(MMD血管)；其中病变呈双侧8例．单侧4例。12例中头颅CT表现有梗塞灶4例，脑出血5例，其余3例表现正常。结论 除DsA外．MRI和MRA是两种可以很好评价Moyamoya病的影像学方法。若儿童或青壮年发生脑血管病，反复出现脑梗死或出现脑室出血、脑叶出血或蛛网膜下腔出血(SAH)则要考虑Moyamoya病的可能。     

DWI及MRA在大面积脑梗塞早期诊断中的价值

目的:评价弥散加权磁共振成像DWI和磁共振血管成像MRA对早期大面积脑梗塞的诊断价值。方法:对24例早期大面积脑梗塞的临床和磁共振资料进行分析,全部患者均行DWI及MRA检查。结果:24例早期大面积脑梗塞中,13例急性期CT扫描未检测出确切病灶,DWI扫描全部出现大片异常高信号,病灶检出率为100％。而在常规T2WI检查中,7例为阴性,病灶检出率为69％。MRA发现血管异常24例,表现为供血动脉闭塞,狭窄、硬化。结论: DWI有助于明确早期大面积脑梗塞病变范围,且能区别新旧病灶。MRA能直接显示大面积脑梗塞闭塞的供血脑血管,联合使用DWI和MRA对早期大面积脑梗塞诊断有重要的临床价值,也有利于早期合理的治疗方案制定及预后判断。     

烟雾病的MRI和MRA诊断

目的探讨磁共振成像(MRI)和磁共振动脉成像(MRA)对烟雾病的诊断价值。方法回顾性分析22例烟雾病患者的临床和影像资料,全部行MRI和MRA(3D-TOF法)检查,其中10例进行了DSA检查。结果MRI上脑实质内均出现异常信号,其中脑梗死8例,脑出血7例,脑萎缩3例,脑软化4例,8例患者在基底节区有血管流空现象。MRA均良好显示病变血管狭窄或闭塞,呈多支受累,与DSA所见相似。结论MRI结合MRA是诊断烟雾病的无创和有效手段。     

Quantitative magnetic resonance angiography of the cerebrovasculature in physiologic and pathologic states.

BACKGROUND: In the past, clinical decisions regarding treatment of neurovascular disorders leading to ischemia have been guided by the percentage of stenosis of the vessel in question. However, such an approach assumes a predictable and stable relationship between the percentage of stenosis and the degree of flow reduction it causes. Historically, this type of relationship has been difficult to document. Thus, a method for noninvasively measuring the absolute flow of specific cerebral arteries is of potential practical value. METHODS: We set to quantify the mean blood flow (Qm, in mL/min) in the cerebral arteries using quantitative magnetic resonance angiography (QMRA), and to compare the findings in normal vessels with those found in vessels considered pathologically narrowed. Specific vascular segments were identified, studied, and the results entered into a database. Statistical analyses of the measurements were carried out using StatPlus for Microsoft Excel. It involved comparing of the Qm found in specific vessels, as well as those found in normal and abnormal vessels, using analysis of variance (ANOVA). The abnormal vessels were selected from specifically identified magnetic resonance angiography (MRA) studies. RESULTS: A total of 57 patients, 26 men and 31 women, with ages ranging from 19 to 86 years (mean = 64.5), underwent MRA with subsequent QMRA of 157 arteries. The latter included 72 internal carotid (ICA), 45 vertebral (VA), 18 common carotid (CCA), 13 middle cerebral (MCA), and nine basilar (BA) arteries. The mean Qm obtained were CCA = 313.9 (+/-115.4), ICA = 231.1 (+/-83.7), VA = 90.5 (+/-45.8), MCA = 92.5 (+/-62.3) and BA = 120.1 (+/-64.5). ANOVA showed significant differences between individual vessels (P < .00001). The values obtained were consistent with those predicted mathematically, as derivatives of their proportional contributions to overall cerebral arterial flow (Qbrain) as a product of the normal cardiac output (CO) [ie, Qbrain = CO*.2]. Further ANOVA of the normal and abnormal vessels showed statistically significant differences between the two groups (186.5 +/- 108.6 vs. 117.9 +/- 76.1, respectively; P= .000514). CONCLUSIONS: The use of QMRA provides the mean for direct measurement of absolute blood flow within the cerebral arteries in physiologic and pathologic states. This technique may be of future importance in characterizing absolute flow compromise in the cerebral arteries under a variety of clinically relevant circumstances.     

A pediatric case of reversible cerebral vasoconstriction syndrome with cortical subarachnoid hemorrhage

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare disorder characterized by acute onset, severe headache, with reversible vasoconstriction of cerebral arteries often accompanied by additional neurological symptoms. This syndrome is seen mainly in middle-aged adults, predominantly women. Herein, we report on a pediatric case of RCVS with cortical subarachnoid hemorrhage (SAH). A 12-year-old boy developed acute, severe headache with paralysis of lower extremities causing gait disturbance after administration of eletriptan. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries, whereas magnetic resonance imaging (MRI) demonstrated sulcal hyperintensity on fluid-attenuated inversion recovery, consistent with cortical SAH. The patient's clinical symptoms resolved spontaneously after a few days and the MRI and MRA findings disappeared 3months later, suggesting a diagnosis of RCVS. Eletriptan might cause vasoconstriction of cerebral arteries. Although most patients with RCVS are adults and pediatric cases are rare, RCVS should be considered in a child complaining of severe headache.     

Validation of hyperintense middle cerebral artery sign in acute ischemic stroke Comparison between magnetic resonance imaging and angiography

We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.     

Successful serial imaging of the mouse cerebral arteries using conventional 3-T magnetic resonance imaging

Serial imaging studies can be useful in characterizing the pathologic and physiologic remodeling of cerebral arteries in various mouse models. We tested the feasibility of using a readily available, conventional 3-T magnetic resonance imaging (MRI) to serially image cerebrovascular remodeling in mice. We utilized a mouse model of intracranial aneurysm as a mouse model of the dynamic, pathologic remodeling of cerebral arteries. Aneurysms were induced by hypertension and a single elastase injection into the cerebrospinal fluid. For the mouse cerebrovascular imaging, we used a conventional 3-T MRI system and a 40-mm saddle coil. We used non-enhanced magnetic resonance angiography (MRA) to detect intracranial aneurysm formation and T2-weighted imaging to detect aneurysmal subarachnoid hemorrhage. A serial MRI was conducted every 2 to 3 days. MRI detection of aneurysm formation and subarachnoid hemorrhage was compared against the postmortem inspection of the brain that was perfused with dye. The imaging times for the MRA and T2-weighted imaging were 3.7±0.5 minutes and 4.8±0.0 minutes, respectively. All aneurysms and subarachnoid hemorrhages were correctly identified by two masked observers on MRI. This MRI-based serial imaging technique was useful in detecting intracranial aneurysm formation and subarachnoid hemorrhage in mice.