椎动脉与基底动脉粥样硬化所致双侧脑干梗死形态及分布的对比研究

目的探讨椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死患者梗死灶的形态以及分们的特点。方法回顾性分析25例椎动脉或基底动脉粥样硬化所致双侧脑干梗死患者的影像学资料,根据血管病变部位分为椎动脉病变组（17例）和基底动脉病变组（8例）,比较两组患者的梗死灶的形态以及分布情况。结果①17例椎动脉病变患者均存在双侧椎动脉闭塞或严重狭窄（狭窄率为70％～99％）,其中8例为双侧椎动脉闭塞,9例为一侧椎动脉闭塞合并对侧椎动脉重度狭窄,病变部位多位于颅内;基底动脉病变组8例患者中,基底动脉闭塞3例,狭窄5例,其中3例为重度狭窄,2例狭窄率为50％～69％。②椎动脉病变组和基底动脉病变组双侧脑干多发性小梗死灶（〈1cm）分别为15例（15／17）和3例（3／8）,P〈0．05;单个大梗死灶（≥1cm）累及双侧脑十分别为3例（3／17）和6例（6／8）,P〈0．05;合并小脑梗死分别为13例（13／17）和2例（2／8）,P〈0．05。,结论椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死梗死灶的形态以及分布有所不同,前者双侧脑干多发小梗死灶较多见,后者累及双侧脑干的大梗死灶多见。     

椎动脉优势对基底动脉弯曲及椎基底动脉连接部脑梗死的影响

目的探讨椎动脉优势对基底动脉弯曲及椎基底动脉连接部位脑桥和小脑梗死的影响。方法选择单侧脑桥或小脑后下动脉供血范围的梗死患者91例(梗死组),分析影像学资料,包括梗死侧别、椎动脉优势、基底动脉弯曲和它们的方向性关系,另选健康体检者83例(对照组)。多因素分析基底动脉弯曲的预测因素。结果梗死组椎动脉优势常发生于左侧(P<0.01)。76例患者椎动脉优势与基底动脉弯曲呈反方向(P<0.01)。脑桥梗死发生于基底动脉弯曲的对侧,小脑后下动脉梗死发生于非优势椎动脉侧(P<0.01)。与对照组比较,梗死组基底动脉弯曲方向、基底动脉弯曲分级及右侧椎动脉直径差异有统计学意义(P<0.01)。多因素分析表明,椎动脉直径是预测基底动脉中、重度弯曲的惟一预测因素(OR=2.70,95%CI:1.22～5.98)。结论椎动脉流速不对称是基底动脉弯曲的重要血流动力学因素,这增加椎基底动脉连接部的脑梗死。     

双侧脑干梗死患者临床影像学的特征和病因分析

目的比较单侧和双侧脑干梗死患者临床影像学特征和病因,并重点分析双侧脑干梗死灶的分布模式及其可能的脑卒中机制。方法选择头颅弥散加权成像所证实的急性梗死灶累及脑干的患者338例,其中单侧脑干梗死组286例,双侧脑干梗死组52例。结果与单侧脑干梗死组比较,双侧脑干梗死组患者临床症状较重和短期预后较差,且多发脑干梗死灶(73.1%vs 5.6%)、合并小脑梗死(53.8%vs 5.6%)和合并大脑后动脉梗死(26.9%vs2.8%)更为多见(P0.01)。大血管粥样硬化是双侧脑干梗死患者最常见的脑卒中病因(基底动脉粥样硬化19例;椎动脉粥样硬化21例)。基底动脉粥样硬化患者所致双侧脑干大梗死(47.4%vs 14.3%)、单发脑干大梗死(31.6%vs 4.8%)和脑干大梗死横跨脑干中线(47.4%vs 4.8%)较椎动脉粥样硬化患者所致双侧更多见(P0.05,P0.01);而椎动脉粥样硬化患者所致双侧多发脑干内部小梗死较基底动脉粥样硬化患者所致双侧更多见(52.4%vs 10.5%,P0.01)。结论基底动脉和椎动脉粥样硬化所致双侧脑干梗死的梗死灶分布模式存在不同之处,提示上述两种情况下的脑卒中机制也存在差异。     

基底动脉发育不全在脑桥穿支动脉梗死患者中的作用研究

目的探讨基底动脉发育不全(BAH)与脑桥穿支动脉梗死的关系及其临床特点。方法选择头颅MRI确诊的急性脑梗死患者328例,根据诊断分为BAH组27例和无BAH组301例。其中急性后循环穿支动脉梗死患者79例,通过头颅磁共振血管造影术评估基底动脉直径(BAH定义为直径<2 mm)、椎动脉V4段发育不全(V4AH)及胚胎大脑后动脉(FTP)情况。结果 BAH组后循环梗死、动脉发育不全(单侧V4AH、双侧V4AH、单侧FTP、双侧FTP、双侧V4AH和FTP)比例明显高于无BAH组(P<0.01)。79例急性后循环穿支动脉梗死患者中,BAH 24例(30.4%),其中脑桥穿支动脉梗死15例(62.5%),后循环其他部位穿支动脉梗死9例(37.5%)。在脑桥穿支动脉梗死患者中,合并BAH的比例明显高于未合并BAH的比例(62.5%vs 12.7%,P<0.01)。结论 BAH与脑桥穿支动脉梗死的发生有密切关系,这些患者多合并V4AH和FTP。     

基底动脉过长弯曲的3．0T MRI研究

目的应用3．0T MRI研究基底动脉过长弯曲的影像学表现。方法对MRI检查显示基底动脉过长弯曲患者155例行颅脑MRI及MRA检查,对基底动脉MRI及MRA各指标进行分析,观察患者脑实质情况。结果基底动脉向右扭曲97例,向左扭曲58例;颅脑MRI平扫见后循环梗死或软化灶80例;基底动脉的位置与椎动脉的粗细相关（Х^2=55．151,P〈0．01）。结论MRI与MRA联合可清楚地显示基底动脉的形态、走行及其与后颅凹诸结构的关系。     

高分辨率磁共振对桥脑旁正中梗死的诊断应用

目的探讨高分辨率磁共振(high-resolution MRI,HRMRI)对脑桥旁正中梗死的诊断价值。方法收集经MR证实的脑桥旁正中梗死患者21例,分别行磁共振血管成像(MRA)和HRMRI检查,比较MRA与HRMRI在识别基底动脉狭窄的异同,并利用HRMRI观察动脉粥样硬化斑块在基底动脉的分布和梗死部位的关系。结果 MRA发现8例有基底动脉狭窄(狭窄率38.10%),而HRMRI发现18例有基底动脉狭窄(狭窄率85.71%),两种方法发现基底动脉狭窄率比较差异有统计学意义(P0.01)。18例基底动脉狭窄的患者中动脉粥样硬化斑块主要位于梗死同侧占16例(88.89%),对侧仅2例(11.11%)。结论 HRMRI发现基底动脉狭窄的检出率高,同时发现桥脑旁正中梗死患者基底动脉斑块大多分布在脑桥梗死的同侧。     

基底动脉过长弯曲的3.OT MRI研究

目的 应用3.0T MRI研究基底动脉过长弯曲的影像学表现.方法 对MRI检查显示基底动脉过长弯曲患者155例行颅脑MRI及MRA检查,对基底动脉MR/及MRA各指标进行分析,观察患者脑实质情况.结果 基底动脉向右扭曲97例,向左扭曲58例;颅脑MRI平扫见后循环梗死或软化灶80例;基底动脉的位置与椎动脉的粗细相关(χ2=55.151,P<0.01).结论 MRI与MRA联合可清楚地显示基底动脉的形态、走行及其与后颅凹诸结构的关系.     

颅外颈部动脉狭窄发生率的磁共振血管成像评价

目的探讨磁共振血管成像对105例椎基底动脉供血不足和/或短暂性脑缺血发作患者的颅外颈部动脉狭窄发生率的评价。方法收集椎基底动脉供血不足和/或短暂性脑缺血发作患者105例,按年龄段分为青中年组、中老年组和老年组,同时设无明显临床症状者为对照组。所有病例均接受颅外颈部磁共振时间飞跃法血管成像和增强磁共振血管成像检查,分析比较其血管狭窄情况。结果105例有临床症状者(127个部位)颅外颈部动脉各部位狭窄发生率为椎动脉起始端狭窄31.49%、椎动脉远端颅内段狭窄18.11%、一侧椎动脉发育不良和全程细窄18.11%、椎动脉迂曲走行伴有椎动脉局限性硬化狭窄16.53%、颈内动脉硬化狭窄12.60%、颈总动脉硬化狭窄3.15%,同时合并2个以上部位狭窄者17例(39个部位)。按不同年龄分组,各部位狭窄发生率按上述顺序分别为:青中年组30.77%、25.64%、28.21%、7.69%、7.69%和0%;中老年组36.59%、19.51%、14.63%、17.07%、9.76%和2.44%;老年组27.66%、10.64%、12.76%、23.40%、19.15%和6.38%。结论颅外颈部动脉病变中椎动脉起始端狭窄发生率明显高于其它部位;随年龄增长,椎动脉及颈动脉硬化狭窄发生率增加;磁共振血管造影对颅外颈部动脉狭窄发生率的研究有重要价值。     

基底动脉弯曲与脑干梗死患者早期预后不良的相关性研究

目的 探讨基底动脉弯曲与脑干梗死患者早期预后不良的关系。方法 回顾性纳入2020年4月至2022年5月常州市第二人民医院神经内科收治的脑干梗死患者171例，根据患者入院72 h内扩展版美国国立卫生研究院卒中量表(e-NIHSS)评分是否较入院时增加≥2分，分为预后不良组46例与预后良好组125例。所有患者均完成头颅MRI检查和CT血管造影(CTA)检查，收集入组患者的相关基线资料和入院e-NIHSS评分等。比较2组患者的基线临床资料及脑干梗死部位等，评估脑干梗死患者早期预后不良的预测因素。结果 2组高血压、入院e-NIHSS评分、椎动脉优势和基底动脉弯曲指数比较，差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示，高血压(OR=3.498,95%CI:1.085～11.271,P=0.036)、入院e-NIHSS评分(OR=1.217,95%CI:1.020～1.453,P=0.029)和基底动脉弯曲指数(OR=1.317,95%CI:1.159～1.496,P=0.001)是脑干梗死患者早期预后不良的独立预测因素。ROC曲线分析发现，基底动...     

基底动脉弯曲及其临床意义

随着神经影像学的发展,基底动脉弯曲检出率明显增高.基底动脉弯曲的发生和发展过程受年龄、基底动脉长度、椎动脉优势等因素的影响.基底动脉弯曲会影响后循环血液供应,并可能造成脑干和脑神经压迫导致相应的临床症状.     

椎基底动脉迂曲扩张症的计算流体力学分析

目的 基于磁共振血管造影(MRA)的椎基底动脉迂曲扩张症(VBD)计算机流体力学分析。方法 选取2018年1月至2022年1月牡丹江医学院附属红旗医院诊断为VBD的40例患者,经MRI检查正常的40例患者图像。以椎基底动脉MRA图像构建椎基底动脉三维几何模型,分为VBD组与对照组,分析血流速度(V)、壁面剪切应力(WSS)及震荡剪切系数(OSI)。结果 VBD组V、WSS及OSI均高于对照组,差异有统计学意义(P <0.05)。在血流速度方面,高速血流集中于基底动脉及右侧大脑后动脉处。在WSS方面,VBD组高WSS位于右侧椎动脉、基底动脉、双侧大脑后动脉等大部分血管区域,以血管分叉处显著。在OSI方面,VBD组高OSI值以基底动脉末端至双侧大脑后动脉发出处明显,其余血管区域为波动性高OSI分布。结论 基于真实磁共振患者图像可建立三维个体化血管模型及进行血流动力学分析,获取VBD血流速度图、血管剪切应力云图及震荡剪切系数云图。建立VBD组及对照组模型,分析血流动力学发现,VBD组的基底动脉段具有高速血流、高WSS及高OSI,以末端显著,临床上应着重关注此区域。     

基底平行解剖扫描磁共振成像联合磁共振血管成像动态监测颅内段椎动脉夹层二例并文献复习

脑血管影像学检查是目前诊断椎动脉夹层的主要依据,是观察动脉夹层形态学改变的重要手段.笔者回顾性分析了2例应用基底平行解剖扫描磁共振成像(BPAS-MRI)联合磁共振血管成像(MRA)显示血管外轮廓并动态监测血管形态学改变的颅内段椎动脉夹层患者的临床资料,并通过PubMed数据库以"Basi-parallel anato...     

小脑分水岭梗死的临床和影像学分析

目的探讨小脑分水岭梗死患者血管病变特点。方法收集178例小脑梗死病例的临床表现及磁共振成像（MRI）、磁共振弥散加权成像（DWI）、磁共振血管造影（MRA）／CT血管造影（CTA）检查结果,按DWI上病灶部位分为小脑分水岭梗死和非分水岭梗死。根据MRA／CTA检查结果将椎一基底动脉狭窄部位分为四种类型：颅内段、颅外段、混合性和未发现狭窄,比较小脑分水岭梗死和非分水岭梗死患者血管病变的特点。结果178例患者中42例符合小脑分水岭梗死;小脑分水岭梗死患者起病时症状较轻,预后良好,但血管狭窄发生率为90．5％,高于小脑非分水岭梗死（74．3％）;颅内段、颅外段、混合性、未发现狭窄4种血管病变类型在小脑分水岭梗死患者中分别占14．3％,52．4％,23．8％,9．5％,在小脑非分水岭梗死中则分别为33．8％,16．2％,24.3％,25．7％。结论尽管小脑分水岭梗死患者有着更为良性的临床表现和预后,但大血管狭窄,尤其是椎动脉颅外段狭窄的发生率高,应早期进行血管内干预治疗。     

椎基底动脉延长扩张症患者的临床特点

 目的 研究椎基底动脉延长扩张症(VBD)患者的临床特点。方法 连续收集2008年10月至2012年2月确诊的VBD患者27例设为VBD组,并设置同期临床表现相似的非VBD脑血管病患者81例为对照组,分析VBD的危险因素、脑血流动力学特点,并总结神经影像学和临床表现特征。 结果 (1)两组患者间在血脂水平及合并基础心脑血管疾病上差异有统计学意义(P<0.05);(2)VBD患者的脑血流动力学特征主要表现为椎基底动脉收缩期峰值血流速度减慢,收缩/舒张比值降低,VBD组和对照组的峰值平均血流速度(-27±9比-40±15)、搏动指数(0.38±0.15比0.78±0.19)、阻力指数(0.48±0.23比0.88±0.18)比较差异均有统计学意义(P值分别为0.036、0.032、0.032);(3)VBD患者临床主要表现为脑梗死,以后循环微小梗死为主,其次表现为脑出血、对周边组织的压迫症状和体征、脑积水等,多合并出现,经MRI检查多可确诊。结论 VBD患者具有相对特异的临床特征,MRI 检查为首选。     

Diagnosis and follow‐up of idiopathic dilatation of inferior vena cava

In the absence of cardiac pathology, the presence of a dilated inferior vena cava (IVC) is considered idiopathic. To date, this phenomenon has only been described in athletic individuals as an adaptation to chronically augmented venous return. This is the largest prospective cohort study, following ten individuals with idiopathic dilated IVC against an age‐matched control group with annual echocardiograms and cardiac magnetic resonance (CMR) imaging for a median of 55 months. No significant difference was found between echocardiography and CMR measurements in IVC diameter assessment both at baseline and at follow‐up. Over the study period, there was no significant progression of the IVC in diameter as measured either by echocardiography or CMR. None of the patients suffered any cardiovascular events, and there were no hospitalizations. Our findings indicate the benign nature of this condition and provide reassurance with regard to future clinical implications.     

双侧自发性椎动脉夹层一例

椎动脉夹层是引起后循环青年卒中重要的病因,其单侧病变多见,且大多患者有明确的外伤史,双侧自发性椎动脉夹层少见.既往研究表明,颅外段椎动脉夹层给予抗血小板聚集和抗凝治疗均有效,且在监测手段上,高分辨率MRI对动脉管壁结构显示优于其他检查手段,故在椎动脉夹层的诊治及随访方面均有明显优势.该研究报道了1例经高分辨率MRI确诊及连续追踪的双侧椎动脉颅外段自发性夹层的罕见案例,该例患者源于一侧起病,虽经双重抗血小板聚集治疗但对侧出现了再发夹层,该研究结合文献对其诊治特征进行了分析.     

Clinical utility of two-dimensional magnetic resonance angiography in detecting coronary artery disease

AIMS: The accuracy of magnetic resonance angiography in detectingproximal coronary artery stenoses is unclear. We postulatedthat fast magnetic resonance angiography is capable of (1) imagingproximal coronary arteries, and (2) detecting stenoses of 50%of their luminal diameter. METHODS AND RESULTS: Thirty-five patients, referred for analysis of angina pectoris,underwent both conventional angiography and magnetic resonanceangiography of coronary arteries. A fast k-space segmented gradient-echotechnique was used during breath-holds. Two observers, blindedto the results of conventional angiography, independently analysedthe magnetic resonance studies for (1) length of visualizedsegments, and (2) presence of signal voids indicative of stenoses.From 140 proximal arteries, 15 (11%) were excluded because ofincomplete imaging or degraded image quality. Mean length ofthe visualized segments was 9±4 mm for the left main,62±16 mm for the left anterior descending, 21±9mm for the left circumflex and 89±32 mm for the rightcoronary artery. Sensitivity for detecting 50% luminal diameterstenoses was 0·00 for the left circumflex, 0·53for the left anterior descending coronary artery, 0·71for the RCA and 1·00 for the left main artery. Specificityvaried from 0·73 for the left anterior descending coronaryartery to 0·96 for the left circumflex. Inter-observeragreement was 0·90. CONCLUSION: Thus, segmented magnetic resonance angiography is capable ofnon-invasive imaging of proximal coronary anatomy. Its goodaccuracy in detecting left main coronary artery disease, intermediateaccuracy in detecting right coronary artery and left anteriordescending coronary artery stenoses, and low accuracy in detectingleft circumflex lesions fit within a range of sensitivitiesand specificities found by others. Further technical advancesare necessary to make the technique clinically robust.     

对比增强磁共振血管造影对椎动脉开口狭窄的诊断价值

目的评价对比增强MR血管造影（CE-MRA）在诊断椎动脉开口狭窄中的价值。方法对108例（216支椎动脉）有临床缺血症状的患者行CE-MRA检查,CE-MRA检查后1周内行DSA检查。以DSA为标准,评价CE-MRA诊断椎动脉开口狭窄的准确性。结果①216支血管中,CE-MRA与DSA检查结果一致的有188支（87.0%）。有24支（11.1%）CE-MRA判定狭窄程度高于DSA。有4支（1.9%）CE-MRA判定狭窄程度低于DSA。两种检查的Spearman秩相关系数rs=0.785,P〈0.001。②CE-MRA诊断为正常的有168支血管,DSA诊断有2支为轻度狭窄（狭窄率≤49%）,2支为中重度狭窄（狭窄率50%～99%）。CE-MRA诊断为轻度狭窄的8支血管中,DSA显示有6支为正常血管;在CE-MRA诊断为中重度狭窄的30支血管中,10支经DSA证实为轻度狭窄,8支为无狭窄。CE-MRA提示闭塞的10支血管,均与DSA显示的一致。③以DSA为金标准,CE-MRA检查的敏感性为89.5%（34/38）,特异性为92.1%（164/178）,假阳性率为7.9%（14/178）,假阴性率为10.5%（4/38）,阳性预测值为70.8%（34/48）,阴性预测值为97.6%（164/168）,诊断一致率为91.7%（198/216）,Youden指数=0.816。结论 CE-MRA诊断椎动脉开口狭窄的敏感性较高,可以作为一种筛查手段;但若准确评价椎动脉狭窄的程度,则需要联合多种检查手段。     

Role of cardiac magnetic resonance imaging in ischaemic heart disease

Cardiac magnetic resonance imaging is a new imaging method that has much to offer clinicians caring for patients with ischaemic heart disease. This article describes briefly the basic principles and practical aspects of cardiac magnetic resonance imaging, and summarizes the pathophysiology of ischaemic heart disease. Then it discusses in detail the use of cardiac magnetic resonance imaging for detection of coronary artery disease, and for assessment of acute and stable coronary syndromes.     

Magnetic resonance imaging of the axial skeleton in rheumatoid disease

The axial skeleton is a target for both spondyloarthritis and rheumatoid arthritis. While conventional radiography allows the clear documentation of the late stages of inflammatory changes, magnetic resonance imaging (MRI) is sensitive enough to depict early inflammatory lesions. It is, therefore, of particular importance for radiologists and clinicians to know the MRI appearances of inflammatory changes of the axial skeleton in rheumatoid diseases. Typical lesions in ankylosing spondylitis and related conditions comprise spondylitis (Romanus lesion), spondylodiscitis (Andersson lesion), arthritis of the apophyseal joints, the costovertebral and costotransverse joints, and insufficiency fractures of the ankylosed vertebral spine (non-inflammatory type of Andersson lesion). Sacroiliitis is associated with chronic changes such as sclerosis, erosions, transarticular bone bridges, periarticular accumulation of fatty tissue and ankylosis. In addition, acute findings include capsulitis, juxta-articular osteitis and the enhancement of the joint space after contrast medium administration. Another important sign of spondyloarthritis is enthesitis, which affects the interspinal and supraspinal ligaments of the vertebral spine and the interosseous ligaments in the retroarticular space of the sacroiliac joints. The main site of manifestation of spinal involvement in rheumatoid arthritis is the cervical spine. Typical changes are the destruction of the atlantoaxial complex by pannus tissue with subsequent atlantoaxial subluxation, basilar impression and erosion of the dens axis. Changes in the lower segments of the cervical spine are destruction of the apophyseal joints resulting in the so-called stepladder phenomenon. Because of the uniform response of the discovertebral complex to different noxae, a number of different conditions must be distinguished on the basis of the patient's clinical findings and history in combination with their imaging appearance. These conditions comprise degenerative disc disease, septic spondylodiscitis, Scheuermann's disease, Paget's disease and diffuse idiopathic skeletal hyperostosis (DISH).