椎动脉型颈椎病MRI与MRA的临床应用

目的：回顾性评价和比较椎动脉型颈椎病的ＭＲＩ与ＭＲＡ影像学价值。方法：１３例中均有颈椎退变及颈性眩晕，ＭＲＩ采用ＳＥＴ１ＷＩ和Ｔ２ＷＩ，或ＧＲ序列，轴位，矢状位、冠状位成像。用２Ｄ－ＴＯＦＭＲＡ检查。结果：９／１３例（６９．２％）中钩突增生，小关节突增生２例，椎间盘变窄４例，椎间盘外侧型突出３例，椎体不稳４例，颈椎横突骨折１例，以上原因造成椎动脉的扭曲，变细狭窄，闭塞等。ＭＲＡ示椎动脉狭窄变细７例，阻塞２例。椎动脉迂曲１１例，均与颈椎病有关。结论：ＭＲＩ与ＭＲＡ联合评价椎动脉型颈椎病是获得信息最多的组合方式，其临床应用将更广泛     

椎动脉型颈椎病的发病机理初探

目的：探讨椎动脉型颈椎病的发病机理。方法：（１）对４具鲜尸进行双侧椎动脉Ｘ线造影、双侧颈椎横突孔ＣＴ平扫,并对其大体解剖和病理进行观察。（２）对３８例眩晕病人进行椎动脉ＭＲＡ检查,并对其中３例进行了ＣＴ颈椎横突孔平扫。（３）另以２８例正常人为对照组,进行ＭＲＡ检查,方法和条件同病人组,ＭＲＡ采用二维时间飞越法（２ＤＴＯＦＭＲＡ）。结果：（１）尸体解剖及椎动脉造影显示血管壁粗糙变硬４处,弯曲８处、血管壁含有胆固醇结晶２处（Ｃ１,２处）、纤维粘连带６处、钩突关节增生８处、关节突骨刺５处。（２）ＭＲＡ如传统血管造影一样能显示椎动脉闭塞、狭窄和扭曲。病人组与对照组椎动脉的ＭＲＡ表现有显著差异（Ｐ＜０．００１）。结论：椎动脉粥样硬化而致血管狭窄、管壁僵硬、血管弹性减弱应是椎动脉型颈椎病的一个重要的病理基础;椎动脉周围的骨性结构和软组织的增生、肥厚以及椎体移位直接和／或间接所致椎动脉管径狭窄应属椎动脉型颈椎病发病的外在因素,而体位的异常如颈椎伸屈、旋转等则是其诱发因素     

颈椎病椎动脉血流的MR测量研究

颈椎病椎动脉血流的ＭＲ测量研究陈彦徐家兴李恩中张光武颈椎病是临床常见病。颈椎常规ＭＲＩ可精确地显示椎间盘变性突出、椎间孔和椎管狭窄、脊髓受压及髓内异常信号，对神经根型、脊髓型颈椎病的诊断具有较高参考价值，但对椎动脉型颈椎病尚较难提供可靠的诊断依据。Ｍ...     

低张力MRI与内窥镜对照评价十二指肠乳头区的研究

目的 探讨ＭＲＩ评价十二指肠乳头区的价值。方法 ４２例患者做了低张力ＭＲＩ、磁共振胰胆管成像（ＭＲＣＰ）及十二拽肠内窥镜对照检查。结果 ４２例患者中，ＭＲＩ清楚显示３５例十二指肠乳头，占全部病例的８３％，ＭＲＩ显示十二指肠头正常者１６例，炎性水肿１２例，早期壶腹癌７例，ＭＲＩ显示十二指肠乳头与内窥镜近似，显示壶腹癌优于内窥镜。结论 低张力ＭＲＩ结合ＭＲＣＰ可作为十二指肠乳头区全面，精细的无创检查法     

先天性主动脉缩窄的磁共振成像诊断

目的研究先天性主动脉缩窄（ＣｏＡ）的磁共振成像（ＭＲＩ）征象并与超声心动图（Ｅｃｈｏ）和手术对照，探讨其在诊断中的意义和作用。方法ＣｏＡ１２例，单纯型１０例，复杂型２例。１０例经手术证实，１例行ＤＳＡ，１例行血管造影和经皮主动脉球囊成形术。ＭＲＩ均行ＳＥ序列成像，其中８例兼作梯度回波（ＧＲＥ）的电影（ｃｉｎｅ）ＭＲＩ或（和）ＭＲ血管造影（ＭＲＡ）。所有病例均有经胸Ｅｃｈｏ检查。结果９例（７５％）ＭＲＩ显示为局限性膜状或嵴状狭窄，３例（２５％）呈长管状狭窄。８例ｃｉｎｅＭＲＩ或（和）ＭＲＡ均能显示狭窄段和扩张的肋间动脉和乳内动脉等侧支循环。１２例ＣｏＡ，ＭＲＩ均获得正确诊断，Ｅｃｈｏ８例（６６．７％）获正确诊断。结论ＭＲＩ是检查ＣｏＡ的一种优良的无创性方法，能准确判断狭窄部位、形态、范围和程度，显示狭窄前、后主动脉及头臂血管改变，以及侧支循环情况。对ＣｏＡ的诊断优于Ｅｃｈｏ，基本上可取代血管造影检查。     

磁共振成像在主动脉疾病中的应用(附29例分析)

目的：评价ＭＲＩＳＥ序列，梯度回波（ＧＲＥ）及磁共振血管成像（ＭＲＡ）对主动脉疾病的诊断价值。材料和方法：２９例主动脉疾患，其中主动脉夹层２１例，胸、腹主动脉瘤８例。全部病例采用ＭＲＩＳＥ常规序列及ＧＲＥ技术，４例行ＭＲＡ检查。结果：在ＳＥ及ＧＲＥ序列上２１例胸、腹主动脉夹层均显示真假两腔，其内膜片分别为１９和２１例。破口分别为５和８例。ＭＲＩ及ＭＲＡ能清晰地显示主动脉瘤和瘤体内结构。结论：ＭＲＩ对主动脉疾患具有肯定的诊断价值。以常规ＳＥ序列为基础，辅以ＧＲＥ及ＭＲＡ技术将能对主动脉疾病提供更多的诊断信息。     

脑动静脉畸形的MRI及MRA诊断价值

目的：研究脑动静脉畸形（ＡＶＭ）的ＭＲＩ特征,探讨其诊断价值。方法：使用ＧＥｓｉｇｎａ ｅｃｈｏ ｓｐｅｅｄ１．５Ｔ超导ＭＲ机对７１例ＡＶＭ患者分别行ＭＲＩ及ＭＲＡ检查。ＭＲＩ采用ＳＥＴ１和ＦＳＥＴ２加权序列,ＭＲＡ采用３Ｄ－ＴＯＦ序列。结果：ＭＲＩ及ＭＲＡ能显示ＡＶＭ的瘤巢,ＡＶＭ的继发改变ＭＲＩ能很好显示,ＭＲＡ能显示ＡＶＭ的三维解剖结果。结论：ＭＲＡ和ＭＲＩ是无创性评从脑ＡＶＭ的有效方法,两     

磁共振快速液体衰减反转恢复序列对亚急性和慢性蛛网膜下腔 …

目的 研究ＭＲ快速液体衰减反转恢复（ＦＬＡＩＲ）序列诊断亚急性和慢性蛛网膜下腔出血（ＳＡＨ）的价值。方法 ３０例头部健康者和１７例次ＳＡＨ患者在发病后第４￣３５天进行头部ＭＲＩ检查。扫描机为０．５Ｔ超导ＭＲ机。观察亚急性和慢性ＳＡＨ在ＦＬＡＩＲ的信号表现,并与同期ＣＴ和常规ＭＲＩ所见比较。再对４６个正常和病变的ＦＬＡＩＲ图像做双盲比较分析,以评价其诊断可靠性。结果 ＦＬＡＩＲ成像显示亚急性和慢性Ｓ     

颈静脉孔区肿瘤的MRI和MRA诊断（附五例报告）

目的：分析颈静脉孔区肿瘤的影像学特点，探讨ＭＲＡ对其诊断与鉴别诊断的价值。材料与方法：对５例经手术病理证实的颈静脉孔区肿瘤（颈静脉球瘤２例、神经鞘瘤２例、脑膜瘤１例）病人行ＭＲＩ和ＴＯＦ法ＭＲＡ检查，应用１．０Ｔ超导ＭＲ系统，在常规ＭＲＩ基础上采用２Ｄ或３ＤＦＩＳＰ序列和ＭＩＰ图像后处理技术获取ＭＲＡ图像。４例有ＣＴ，３例有ＤＳＡ资料。结果：ＭＲＩ显示了全部病灶和颈静脉孔的扩大与破坏，准确定性诊断了４例，结合ＭＲＡ后，５例均正确定性诊断。颈静脉球瘤的ＭＲＩ瘤内流空征和ＭＲＡ血管团块征颇具特征性。神经鞘瘤与脑膜瘤的ＭＲＩ信号有别，且前者易囊变，两者ＭＲＡ均未显示肿瘤血管。结论：ＭＲＩ，尤其结合ＭＲＡ对颈静脉孔区肿瘤诊断与鉴别诊断颇有价值。     

小儿急性偏瘫的MRI和MRA表现及临床应用价值

目的：探讨小儿急性偏瘫的常见病因、ＭＲＩ及ＭＲＡ表现特点、鉴别诊断及临床应用价值。材料方法：患儿４４例，单纯行ＭＲＩ检查者１２例，行ＭＲＩ与ＭＲＡ检查者３２例。磁共振检查使用２．０Ｔ超导型扫描机。结果：４４例急性偏瘫患儿中，２９例为脑血管病变，１０例为脑炎，４例为占位性病变，１例为小脑扁桃体下疝。结论：小儿急性偏瘫以脑血管病变为首要病因，且以脑缺血性病变最多见。脑炎为急性偏瘫的第二位病因，以散发性脑炎多见。ＭＲＩ与ＭＲＡ检查相结合对于小儿急性偏瘫的诊断及鉴别诊断有着重要的作用。     

椎动脉型颈椎病的CT和MR成像

目的:探讨多层螺旋CT和磁共振成像对椎动脉型颈椎病的诊断价值。方法:随机抽取CT检查和MRI检查显示异常患者各30例,30例全部行颈部MRI和MRA检查;30例行CTA检查。结果:MRA及CTA均显示椎动脉变细、扭曲、局限性狭窄、闭塞或走行失常等改变;但显示骨质结构CT优于MRI检查;MRI无射线损伤。结论:MRA与MRI联合应用及多层螺旋CTA检查均是诊断椎动脉型颈椎病较为理想的检查手段。     

椎动脉型颈椎病的CT诊断价值

本文通过测量265例成人颈椎横突孔的直径,制定出我国成人横突孔直径的正常下限。结合临床资料着重讨论评价横突孔大小形态对椎动脉型颈椎病的诊断价值。     

闭合性颈椎创伤伴椎动脉损伤的临床研究

目的　研究椎动脉损伤在闭合性颈椎创伤中的发病率及其与颈椎损伤机制、类型、损伤程度的相关性 ,观察椎动脉损伤后的临床症状、体征 ,探讨早期正确诊断的方法。　方法　于2 0 0 0年 8月～ 2 0 0 2年 2月间 ,利用颈部动脉磁共振血管造影 (MRA)技术 ,连续观察 4 6例闭合性颈椎创伤患者 ,结合颈椎X线、MRI、CT检查及患者的临床症状、体征综合分析。　结果 4 6例闭合性颈椎创伤中 ,12例 (2 6 % )伴椎动脉损伤。其中 7例为双侧损伤 (4例一侧未显影、一侧狭窄 ,3例双侧狭窄 ) ,5例为单侧损伤 (均为一侧狭窄 ) ;10例椎动脉损伤患者无任何症状 ,2例出现眩晕、恶心呕吐、面部麻木、偏盲等症状。椎动脉损伤与屈曲型损伤及颈椎严重不稳定相关 (P <0 .0 5 ) ,与小关节绞锁、横突孔骨折及脊髓完全性损伤明显相关 (P <0 .0 1)。　结论　椎动脉损伤是闭合性颈椎创伤的较常见并发症 ,其临床症状体征缺乏特异性。颈椎创伤中的颈椎严重不稳定、屈曲型损伤、伴有脊髓完全性损伤、小关节绞锁和 (或 )横突孔骨折应高度怀疑椎动脉损伤。临床医师应对此类损伤有较高的警惕性 ,常规进行颈部动脉MRA检查是最有效的早期正确辅助诊断方法。     

益脑推拿法对椎动脉型颈椎病患者颈椎生理曲度的影响

目的:观察益脑推拿法对椎动脉型颈椎病患者颈椎生理曲度的影响。方法:160例患者随机分为益脑推拿组(80例)和常规推拿组(80例),采用Borden氏法测量颈椎生理曲度,疗程结束后对两组患者颈椎生理曲度值的变化进行对照分析。结果:治疗后益脑推拿组、常规推拿组的颈椎生理曲度值分别为4.30±1.23 mm、3.55±1.82 mm,两组差别有显著性意义(t′=3.0309,P<0.05)。结论:改善或重建颈椎生理曲度可能是益脑推拿法治疗椎动脉型颈椎病的作用机制之一。     

Rotational changes in the morphology of the vertebral artery at a common site of artery dissection.

OBJECTIVE: Given that vertebral artery dissection and transient vertebrobasilar insufficiency occurs commonly at the C1-C2 junction, the objective was to study, in vivo, the normal rotational anatomy at C1-C2 using magnetic resonance angiography (MRA) with 3-dimensional (3D) reconstructions and to correlate these reconstructions with our experience of dissection location. METHODS: 3D phase-contrast MRAs were obtained from the foramen magnum to C3 in 4 normal volunteers in neutral and rotated (45 degrees) positions. The magnitude images were used as source images for 3D reconstruction. The images from only 1 of the volunteers were completely motion free, and these were subjected to arterial length calculations using image analysis wire frame outline of the vessel. All angiograms of vertebral artery dissection obtained at our institution from 1993 to 1997 were also reviewed. RESULTS: 3D reconstructions document elongation (approximately 7% in quantitatively analyzed case) and slight narrowing of the artery contralateral to the direction of head rotation from C2 to the dural entry point. The artery turns most sharply and is subject to the anterior force of the rotating C1 vertebra as it exits the C1 foramen. Of 14 cases of vertebral artery dissection, 50% occurred between the transverse foramen and the posterior lamina of C1. CONCLUSIONS: With head rotation, the contralateral vertebral artery undergoes the greatest anatomical distortion as it exits the C1 transverse foramen. This increased stress may account for the higher frequency of dissections at this location.     

颈椎病致椎-基底动脉供血不足的影像表现

目的 依据临床与影像表现,探讨颈椎病致椎-基底动脉供血不足的机制及防治要点。方法 122例颈椎病患者均经磁共振血管成像(MKA)和常规X线检查,部分病例还经CT扫描检查。分析影像表现与临床经过的关系。结果 122例患者中,颈椎动脉MRA显示正常者106例(86.89％),各种异常者共16例(13.19％),其中,先天性发育不良3例,扭曲纤细6例,单侧缺如1例,畸形1例,硬化性改变2例,以及狭窄3例。约85％(103/122)的病例经保守性治疗后,于2周至2个月期间临床症状明显缓解或消失。结论 虽然颈椎骨质增生与横突孔狭窄可导致颈椎病发生。但是,作者认为临床上较多遇到的、更为重要的病因是颈交感神经受到激惹引起椎动脉痉挛进而诱发本病。临床上最关键的防治措施是防止颈椎失稳。     

MR Imaging for Assessing Acute Vertebral Trauma

Magnetic resonance imaging (MRI) has revolutionized the imaging assessment of patients sustaining acute vertebral injury and is indicated for all hemodynamically stable patients with acute neurologic deficits related to spinal column injury, particularly in the cervical region. MRI defines the presence and extent of lesions involving osseous structures, ligaments and other soft tissues, and the spinal cord parenchyma. Information obtained from MRI is useful in assessing the indication for and best approach to surgical management of vertebral injury by revealing herniated disc material, epidural hematoma, significant osteophytes, and level(s) of probable or potential spinal column instability. The appearance of spinal cord lesions by MRI provides prognostic information regarding likely extent of recovery of neurologic function. Magnetic resonance angiography (MRA) can reliably demonstrate vertebral artery injuries not uncommonly associated with cervical spine subluxation/dislocation and fractures crossing the foramen transversarium. Improvements in speed of MR image acquisition and patient physiological support and monitoring compatibility in the MR-environment is making MRI more available and safe for use in the setting of acute major trauma.     

Vertebral artery injury and delayed midbrain infarction after unusual fracture of transverse foramen of C3 noted by bone scintigraphy

Vertebral artery dissection and thrombosis propagation causing neurologic sequelae is a rare complication of minor neck injury. Partial fracture of the transverse foramen of the third cervical vertebral body (C3) is uncommon. The authors report a case of vertebral artery injury and delayed midbrain infarction after an unusual fracture of only the upper half of the transverse foramen of C3, noted initially by bone scintigraphy. No other fracture was noted. A minor penetrating skin wound of the neck was not thought to be related to the fracture of the transverse foramen. The right lateral inferior edge of C2 was believed to have compressed the upper half of the transverse foramen of C3 by lateral hyperflexion. Innate laxity of the cervical spine at the level of C2 with respect to C3 in pediatric patients supports this belief.     

MRI of the cervical spine: rheumatoid arthritis compared with cervical spondylosis

This study is a comparison of the cervical spine MR images from 26 patients with rheumatoid arthritis of the cervical spine with those from an age and sex matched group suffering from cervical spondylosis. Erosion of bone and major atlanto-axial subluxation were confined to rheumatoid arthritis. Soft tissue changes revealed by MRI included distortion of normal ligaments and bursae around the dens, particularly in rheumatoid arthritis. Abnormal masses of soft tissue were found in both groups, but those suggesting acute inflammation were much more frequent in rheumatoid arthritis than in cervical spondylosis. Neural compression was well demonstrated, and in rheumatoid arthritis was usually caused by bony structures whereas in cervical spondylosis it was usually due to disc material. It is concluded that MRI should be used as the first investigation to follow plain films in rheumatoid arthritis of the cervical spine. Bone and soft tissue changes are clearly shown, but interpretation of the images requires the recognition that some observed abnormalities may be due to coincidental cervical spondylosis.     

颈椎创伤继发椎动脉损伤核磁共振血管成像诊断及实验研究

目的 探讨二维时间飞逝效应核磁共振血管成像（2D TOF MRA）对闭合性椎动脉损伤的诊断价值。方法 319例闭合性颈椎创伤患者，采用2D TOF MRA技术进行椎动脉前瞻性检查。14只犬建立颈椎屈曲损伤的撞击伤模型，撞击后摄X线片，24～36h后行椎动脉2D TOF MRA检查及椎动脉血管造影。结果 319例颈椎创伤患者中，52例伴有椎动脉损伤。单侧椎动脉损伤51例，左侧22例，右侧29例；双侧椎动脉损伤1例。14只犬均造成颈椎小关节脱位，MRA检查7只犬一侧椎动脉损伤；2只犬一侧椎动脉成像不完整，MRA诊断为可疑阳性；5只犬双侧椎动脉正常。血管造影显示，8只犬一侧椎动脉损伤，6只犬正常。MRA诊断为阳性的7只犬和阴性的5只犬，血管造影与之一致。MRA诊断为可疑阳性的2只犬，血管造影证实1只为阳性，另1只为阴性。结论 2D TOF MRA检查是诊断闭合性椎动脉损伤可靠、首选的方法，对血管痉挛和小面积内膜损伤尚难以准确鉴别。