成人烟雾病17例临床表现和影像学特点分析

目的探讨成人烟雾病的临床和影像学改变特点。方法回顾性分析17例经常规数字减影血管造影(DSA)、磁共振血管造影(MRA)和/或MRI检查确诊的成人烟雾病患者的临床和影像学资料。结果 17例患者中表现为缺血性脑卒中12例(70.6%),主要表现为偏瘫、失语、头痛及智能减退,还可表现为短暂性脑缺血发作;出血性脑卒中5例(29.4%),主要表现为头痛、意识障碍、偏瘫及抽搐。MRI检查发现缺血性脑卒中累及额叶8例,底节区3例,深部脑白质3例,枕叶3例,颞叶1例;累及单侧半球4例,双侧半球8例;脑萎缩6例。环池内烟雾血管影1例,双侧大脑中动脉累及10例。出血性脑卒中患者中单纯脑室出血2例,蛛网膜下腔出血1例,脑室出血并脑干出血1例,脑室出血并丘脑出血1例。MRA均发现双侧颈内动脉或其分支狭窄或闭塞。全脑DSA检查7例,其中双侧颈内动脉狭窄、闭塞5例,双侧大脑前动脉狭窄或闭塞4例,双侧大脑中动脉狭窄或闭塞3例。结论成人烟雾病临床表现多样,临床特点与责任病灶及支配血管相关;MRI和/或MRA有助于烟雾病的早期诊断,确诊需行全脑DSA检查。     

儿童和成人烟雾病临床及磁共振表现对照分析

目的 探讨儿童和成人烟雾病的临床和磁共振成像表现的异同.方法 回顾分析18例儿童烟雾病和12例成人烟雾病患者的临床、MRI和MRA资料,分析对比其发病诱因、临床症状、MRI和MRA表现.结果 儿童烟雾病以上呼吸道感染为主要诱发因素,成人则以情绪激动和过度劳累为主要诱发因素;临床上儿童以惊厥型和TIA发作型表现为主,成人则以出血型和缺血型表现为主;MRI显示儿童患者脑梗死部位以大脑皮质和皮质下为主,成人患者则以基底节区和放射冠为主;成人患者脑出血发生率明显高于儿童;MRA显示儿童和成人患者颈内动脉、大脑中动脉和大脑前动脉受累几率相似,但成人颈内动脉和大脑中动脉狭窄程度稍重于儿童;成人患者大脑后动脉受累多于儿童;儿童患者颅底侧支血管形成情况优于成人.结论 儿童和成人烟雾病在发病原因、磁共振成像及临床表现上均有一定差别,磁共振成像表现与临床表现具有良好的相关性和一致性.     

3.0T MRI MRA在烟雾病诊断中的应用价值

目的探讨3.0T MRI、MRA在烟雾病诊断中的价值。方法使用3.0T MRI对13例烟雾病患者进行MRI平扫并行MRA成像检查。结果 13例烟雾病患者中MRI平扫发现脑出血2例,脑梗死7例,脑萎缩及脑血管异常4例。MRI主要表现为闭塞血管流空效应消失,侧支循环血管形成,其典型表现为从鞍上池向基底节区走行的条状迂曲低信号以及由于缺血和出血引起的改变,包括多发脑梗死、脑萎缩、脑室扩大及脑内血肿和蛛网膜下腔出血。MRA直接显示血管,表现为多支、双侧血管受累狭窄、闭塞。丰富的侧支循环血管表现为基底节区交织成网团状模糊血管,呈烟雾状。结论3.0T MRI并MRA成像可以较完整客观显示烟雾病的脑内血管狭窄、闭塞及侧支循环重建情况,确诊率高,且检查安全,简便易行,值得临床推广使用。     

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。     

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。     

烟雾病致脑室出血的脑血管影像学特点

目的探讨烟雾病致脑室出血的脑血管影像学特点。方法回顾性分析64例烟雾病致脑室出血患者的临床资料。结果本组患者DSA检查示,双侧病变58例、单侧病变6例,合并动脉瘤4例;均见烟雾状血管。其中双侧大脑前动脉闭塞4例(6.3%),双侧大脑中动脉闭塞2例(3.1%),脉络膜前动脉远端闭塞41例(64.0%),后交通动脉远端闭塞11例(17.2%),单侧颈内动脉分叉处或大脑前动脉A1段、大脑中动脉M1段闭塞共6例(9.4%)。脉络膜前动脉异常扩张和延长108支(84.4%),后交通动脉异常扩张或延长26支(20.3%)。结论脉络膜前动脉和/或后交通动脉扩张、延长是烟雾病致脑室出血的脑血管影像学特点,并且这也可能是烟雾病致脑室出血的主要病因。     

连续40例出血型烟雾病的DSA影像学分析

目的探讨烟雾病患者的DSA影像学诊断特征。方法回顾性分析40例烟雾病病例的DSA影像学表现,40例患者均经CT诊断为颅内出血,均经DSA确诊。结果双颈内动脉末段狭窄闭塞22例,一侧颈内动脉末段狭窄闭塞8例,一侧大脑中动脉狭窄闭塞3例,双侧大脑前动脉和一侧大脑中动脉狭窄闭塞1例,双侧大脑前动脉狭窄闭塞3例,双侧大脑中动脉狭窄闭塞1例,一侧大脑中动脉及对侧大脑前动脉狭窄闭塞2例,均伴颅底异常血管网形成。结论DSA为诊断烟雾病的金标准,DSA检查可清楚显示烟雾病血管狭窄闭塞的部位、侧支循环情况及是否合并动脉瘤,据其表现可指导进一步治疗。     

联合血管重建术治疗成人缺血型烟雾病14例临床分析

烟雾病(moyamoya disease)主要是双侧颈内动脉远端或大脑前动脉、大脑中动脉近端狭窄或闭塞,伴脑底部和软脑膜烟雾状细小血管形成,表现为脑缺血或出血的临床症状。烟雾病的治疗以外科手术为主。2003-07—2012-01作者采用联合血管重建术治疗成人缺血型烟雾病14例,现报告如下。     

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。     

烟雾病致脑室出血的脑血管影像学分析

目的分析烟雾病致脑室出血的脑血管影像学特点。方法回顾性分析经数字减影脑血管造影(DSA)证实的烟雾病致脑室出血患者21例的临床资料和影像学资料。结果结合头CT、MRI检查结果,患者均为脑室出血;DSA显示19例双侧血管病变中,大脑前动脉狭窄1例(4.76%),闭塞1例(4.76%),大脑中动脉闭塞1例(4.76%),后交通动脉远端闭塞3例(14.29%),脉络膜前动脉远端闭塞13例(61.90%);2例单侧病变均为大脑后动脉狭窄或闭塞;42例侧半球中存在脉络膜前端动脉合并后交通动脉扩张、脉络膜前端动脉异常扩张或延长、后交通动脉异常扩张或延长。结论 DSA结合CT、MRI是诊断烟雾病致脑室出血的重要方法。烟雾病致脑室出血的脑血管影像学特点是脉络膜前动脉和(或)后交通动脉扩张破裂,可能是该病的主要病因。     

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。     

成人烟雾病的临床特点及影像分析

目的　研究成人型烟雾病的临床特点、影像表现及其两者的关系。方法　 6 1例经常规血管造影 (包括 DSA)和 MRA确诊的成人型烟雾病患者 (>16岁 )。分析其临床表现及血管造影结果。结果　主要临床表现为突发剧烈头痛、意识障碍 ,伴呕吐、失语及一侧肢体瘫痪。在 CT和 MRI上 ,脑出血 4 1例 (6 7.2 % ) ,脑梗死 15例(2 4 .6 % ) ,脑萎缩 2例 ,无异常表现 3例。在 DSA和 MRA上 ,双侧病变者 32例 ,单侧病变 2 9例 ,5 1例可见到烟雾状异常血管网 ,尤其在出血型患者中。后交通动脉增粗 38支、眼动脉增粗 31支及软脑膜吻合支增多 4 4侧。 5例大面积脑梗死侧支循环很差或缺乏。结论　成人型烟雾病以脑出血多见 ,在发病率和血管造影上和儿童无明显差异。治疗应首选血管重建手术。 DSA为诊断金标准 ,为术前必要检查 ;MRA无创伤性 ,为本病筛选、诊断、随访的首选方法。     

30例烟雾病的临床及影像学特征分析

目的研究烟雾病的临床特点、影像表现及其两者之间关系。方法对30例经磁共振血管成像(MRA)和数字减影全脑血管造影(DSA)确诊的烟雾病患者,分析其临床和影像学特征。结果(1)烟雾病发病年龄在35～45岁左右,发病以脑缺血为主,临床表现以单侧肢体无力或偏瘫最为常见。(2)CT和MRI提示,脑出血11例(36.7%),脑梗死10例(33.3%),脑出血合并梗死灶5例。MRA和DSA均发现大脑前、中、后动脉狭窄或闭塞性病变,双侧病变均多于单侧病变,烟雾状异常血管网分别为5例(45.5%)和29例(100.0%);DSA发现动脉瘤3例(10.3%);后交通动脉增粗13例、前交通动脉增粗7例、眼动脉增粗6例及软脑膜吻合支增多4例。4例大面积脑梗死侧枝循环差。结论烟雾病发病高峰为35～45岁;本病临床表现多样,但以脑缺血常见;MRI和MRA为无创伤性,为本病筛选、诊断、随访的重要方法。对临床疑似病例应及早行DSA检查。     

以皮质蛛网膜下腔出血为首发症状的脑梗死2例报道及文献复习

目的提高对皮质蛛网膜下腔出血(cSAH)为首发症状的大脑中动脉(MCA)狭窄致急性脑梗死的认识。方法报道2例cSAH患者的临床表现、CT和MRI所见、治疗和预后,并复习相关文献进行讨论。结果 2例患者均有高血压病、糖尿病或冠心病史,突发肢体瘫痪,无头痛。头颅CT显示偏瘫对侧大脑皮质沟高密度影,进一步MRI检查提示CT高密度影为SWI低信号出血灶;同时MRA显示偏瘫对侧MCA M1段局限性狭窄,并于同侧放射冠见新发梗死灶。结论 MCA狭窄可以引起cSAH的临床放射综合征,同时伴有新发脑梗死。在cSAH诊断流程中,应该包括应用SWI和MRA检查。     

17例烟雾病的临床特点与DSA分析

目的:研究烟雾病的临床特点、DSA表现。方法对17例经DSA检查确诊的烟雾病患者,分析其临床表现及DSA检查结果。方法:脑缺血表现14例,出血表现3例,DSA上表现为双侧病变6例,单侧病变11例,异常血管网是本病的特征,部分病例的临床表现、CT表现与DSA显示的血管狭窄和闭塞有不一致性。结论:青壮年发生脑血管病, 血压不高,反复出现脑梗死或出现脑室出血或蛛网膜下腔出血者,应考虑MMD的可能,及早做DSA检查。     

A Magnetic Resonance Angiography-Based Study Comparing Machine Learning and Clinical Evaluation: Screening Intracranial Regions Associated with the Hemorrhagic Stroke of Adult Moyamoya Disease

ObjectivesMoyamoya disease patients with hemorrhagic stroke usually have a poor prognosis. This study aimed to determine whether hemorrhagic moyamoya disease could be distinguished from MRA images using transfer deep learning and to screen potential regions that contain rich distinguishing information from MRA images in moyamoya disease.Materials and methodsA total of 116 adult patients with bilateral moyamoya diseases suffering from hemorrhagic or ischemia complications were retrospectively screened. Based on original MRA images at the level of the basal cistern, basal ganglia, and centrum semiovale, we adopted the pretrained ResNet18 to build three models for differentiating hemorrhagic moyamoya disease. Grad-CAM was applied to visualize the regions of interest.ResultsFor the test set, the accuracies of model differentiation in the basal cistern, basal ganglia, and centrum semiovale were 93.3%, 91.5%, and 86.4%, respectively. Visualization of the regions of interest demonstrated that the models focused on the deep and periventricular white matter and abnormal collateral vessels in hemorrhagic moyamoya disease.ConclusionA transfer learning model based on MRA images of the basal cistern and basal ganglia showed a good ability to differentiate between patients with hemorrhagic moyamoya disease and those with ischemic moyamoya disease. The deep and periventricular white matter and collateral vessels at the level of the basal cistern and basal ganglia may contain rich distinguishing information.     

Early ischemic lesion demonstrated by ictal diffusion-weighted MRI during prior TIA in a patient with cerebral infarction]

We reported a patient with transient ischemic attack (TIA), subsequently evolving to a cerebral infarction, in whom ictal diffusion-weighted magnetic resonance imaging (MRI) detected early ischemic lesion in the left hemisphere. The patient was a 30-year-old right-handed male medical doctor, who had an in-hospital episode of TIA with obtundation and right hemiparesis, which lasted for 150 minutes. Ictal diffusion-weighted MRI obtained 110 minutes after symptom onset demonstrated an area of high signal intensity in the left striatum and corona radiata, whereas T 2-weighted and FLAIR images were entirely normal. Ictal magnetic resonance angiography (MRA) showed occlusive lesions in the M 2 branches of the left middle cerebral artery. The second MRA obtained 90 minutes after resolution of the symptoms showed nearly complete recanalization of the left middle cerebral artery, suggesting that the TIA was embolic mechanism. However the patient rapidly developed similar neurological symptoms again 58.5 hours after the TIA episode, evolving finally to a completed stroke. A brain CT obtained 1 hour after the second episode demonstrated diffuse hypodense lesions in the left basal ganglia and corona radiata, and in the left temporal lobe. MRIs 3 and 7 days later displayed completed infarcts, of which distribution was consistent with that of the hypodense lesions on the earlier CT. The left middle cerebral artery remained patent on the follow-up MRAs. The patient fairly recovered and returned to his premorbid position as medical doctor with a mild residual right hand clumsiness. In this patient, ictal and post-ictal MRAs documented an occlusion and a reopening of the middle cerebral artery. The embolic mechanism remains unknown despite detailed cardiac, vascular, and hematological examinations. In addition to recurrent embolism, we would like to point out that the reperfusion injury, secondary delayed neuronal death, and other factors may be involved in the second exacerbation evolving to the completed stroke.