高分辨率磁共振血管壁成像在颅内血管炎性疾病中的进展分析

近年,高分辨率磁共振血管壁成像技术形态(HR-VWI),在针对颅内血管壁组织结构病变展开检查评估工作过程中,正在发挥越来越重要的作用。对HR-VWI技术的运用,能够有效解决处理传统化腔内成像技术形态所具备的缺陷,同时还能在分析揭示人体血管壁组织结构病变引致原因方面发挥良好作用。在HR-VWI技术的运用过程中,能直观准确揭示血管壁组织结构病变的表现特征,改善颅内血管组织病变的诊断准确性。围绕高分辨率磁共振血管壁成像在颅内血管炎性疾病中的进展,展开简要的综述分析。     

颅内动脉粥样硬化影像评估新进展

颅内动脉粥样硬化是导致缺血性脑卒中发生的主要病因之一,尽早明确诊断对患者的后期治疗及预后有重要意义.传统的影像学评估方法不足以准确评估该类疾病,高分辨磁共振血管壁成像(high resolution MR vessel wall imaging,HR-VWI)以及斑块的影像组学快速发展,显示出独特优势,血管内成像以及计...     

高分辨率磁共振血管壁成像在评估颅内动脉瘤稳定性中的研究进展

传统的影像学技术如数字减影血管造影术(digital subtraction angiography,DSA)、CT血管造影术(computed tomography angiography,CTA)及磁共振血管造影术(magnetic resonance angiography,MRA),对颅内动脉瘤的检出、定位及形态学的评估具有一定优势,而对动脉瘤本身血管特征的评估存在很大的局限性。近年来,高分辨率磁共振血管壁成像(high resolution magnetic resonance vessel wall imaging,HR-VWI)逐渐应用于动脉管壁结构的观察与分析,与血管壁的病理特征相结合,对颅内动脉瘤的稳定性进行直接定性评估。笔者将对HR-VWI技术在不同类型颅内动脉瘤中的应用进行综述。     

高分辨率磁共振成像诊断颅内动脉粥样硬化

目的 探讨高分辨率磁共振成像(HRMRI)技术评价颅内动脉粥样硬化的临床价值.方法 51例疑诊颅内动脉硬化患者和10名志愿者均接受常规脑磁共振血管成像(MRA)和大脑中动脉或基底动脉HRMR检查,HRMRI包括FSE-T2WI和DIR-T1WI,并比较MRA和HRMRI的结果.结果 正常颅内动脉管腔显示清晰,管壁呈细线状或不显示.51例患者的51支受检颅内动脉中,10支MRA和HRMRI均未见明显异常;34支MRA和HRMRI显示一致,即MRA显示狭窄、HRMRI显示管壁不同程度的增厚或发现斑块存在;7支MRA和HRMRI显示不一致,其中5支MRA显示正常,但HRMRI显示管壁结构异常(3支有斑块,2支管壁环形增厚),2支MRA显示有狭窄,HRMRI显示管腔外径缩窄,但管壁结构无明显异常.结论 HRMRI能清晰显示颅内动脉的管壁结构,弥补常规MRA技术的不足,对颅内动脉粥样硬化的评价有较高的临床应用价值.     

颅内动脉狭窄斑块特征与缺血性卒中的关系

目的应用高分辨率磁共振成像(high resolution magnetic resonance imaging,HR-MRI)技术分析颅内动脉粥样硬化狭窄患者的斑块特征与发生缺血性卒中事件的关系。材料与方法回顾性分析44例HR-MRI检查的颅内动脉粥样硬化狭窄患者的斑块情况,通过三维时间飞跃法磁共振血管成像(3D-time of flight magnetic resonance angiography,3D-TOF MRA)检查,按管腔狭窄程度将患者分为轻度狭窄组、中度狭窄组和重度狭窄组,根据斑块是否导致缺血性卒中及发生缺血性卒中距HR-MRI检查时间,将斑块分为急性/亚急性期责任斑块组、慢性期责任斑块组、非责任斑块组,比较3组的动脉粥样硬化危险因素(性别、年龄、吸烟史、饮酒史、高血压、糖尿病史、血糖、总胆固醇、高密度脂蛋白、低密度脂蛋白)以及斑块特征(管腔狭窄程度、斑块强化程度)。结果 44例患者中急性/亚急性期责任斑块数目为29个,慢性期责任斑块数目为20个,非责任斑块数目为17个。急性/亚急性期责任斑块组、慢性期责任斑块组、非责任斑块组的管腔狭窄程度、斑块强化程度差异有统计学意义(P0.05);而3组的动脉粥样硬化危险因素差异均无统计学意义。结论颅内动脉粥样硬化狭窄患者斑块强化程度和管腔狭窄程度与是否发生缺血性卒中具有相关性;明显强化的、导致管腔严重狭窄的斑块稳定性更差,更容易发生缺血性卒中。     

颅内动脉粥样硬化性疾病MRA与DSA的对照研究

目的：评价磁共振血管成像（MRA）与全脑血管造影术（DSA）在诊断颅内动脉粥样硬化性疾病（ICAD）中的价值。方法对80例ICAD患者行MRA检查,1周内再行DSA检查。以DSA为标准,评价MRA对颅内动脉粥样硬化狭窄诊断的敏感性和特异性及对颅内动脉粥样硬化性斑块性质的判断。结果1）80例856支颅内动脉MRA与DSA结果一致的有732支,占85.5%;有98支颅内动脉狭窄程度MRA判断高于DSA,占11.1%,MRA对病变血管有夸大判断。2）以DSA为金标准,MRA检查颅内动脉粥样硬化狭窄的敏感性为88.2%,特异性为96.9%,假阳性率为27.2%,假阴性率为3.0%,诊断一致率为91.1%,对DSA和MRA两种检查结果进行一致性检验,P＜0.01,具有高度一致性。3）80例患者MRA检出血管不平整26处,不能区分斑块性质;80例患者DSA检出动脉粥样硬化斑块32处,能区分斑块性质。结论 MRA诊断ICAD敏感性、特异性较高,可以作为一种筛查手段,但若要准确评估颅内动脉狭窄程度,指导介入治疗,需进一步做DSA检查。     

超声血管增强成像技术对大脑中动脉狭窄的诊断价值

缺血性脑卒中是一种致死率和致残率都非常高的疾病,颅内动脉粥样硬化性狭窄占缺血性脑血管病的8％～10％[1].大脑中动脉(MCA)是颅内动脉狭窄最易受累的血管,其狭窄或闭塞是缺血性脑血管病的主要原因.因此,如何提高MCA狭窄的检出率及狭窄程度的准确判定也备受关注.虽然经颅彩色双功能超声(TCCS)是评价MCA狭窄行之有效的方法,但常规二维及彩色多普勒超声对于MCA狭窄后管腔的显示欠清晰,而血管增强成像(Clarify VE)技术恰恰可以提高残余管腔显示的清晰程度,本研究应用该技术联合TCCS检查,旨在探讨这一技术在MCA狭窄诊断中的临床价值.     

3D高分辨率磁共振血管壁成像技术对脑血管病变的评估价值

目的:分析并探讨3D高分辨率磁共振血管壁成像技术对脑血管病变的评估价值,用以提升脑血管疾病检出率。方法:以2019年1月—12月在我院脑内科进行治疗的50例存在颅内动脉粥样硬化的脑血管病变患者作为研究组,另外选择50例同时期在我院进行体检的健康人员组成对照组,对所有人员实施3D高分辨率磁共振血管壁成像技术检测,对比两组动脉狭窄率、斑块面积、增强指数、LSA深度以及LSA数量等影像学特征,分析该技术在脑血管病变评估中的应用价值。结果:研究组受检人员增强指数为(0.89±0.22)%,明显高于对照组的(0.70±0.29)%(t=3.540,P=0.001);LSA深度为(16.72±1.51)mm,较之对照组的(20.78±4.69)mm则明显较低(t=5.589,P=0.000);两组狭窄率、斑块面积、L S A数量等指标则无明显差异(P>0.05)。结论:3D高分辨率磁共振血管壁成像技术对于颅内动脉粥样硬化的检出有关键意义,可以帮助医师准确判断患者病情,通过及时有效干预降低严重脑血管疾病发生概率,具有临床推广价值。     

高分辨率磁共振扫描在颅内动脉狭窄中的应用

目的：探索高分辨率磁共振扫描技术在颅内动脉狭窄处管壁成像中的应用价值。方法采用3.0T 磁共振扫描仪,应用3D-TOF,TIRM,T2WI,T1WI(平扫+增强)序列对37例颅内动脉造影证实的颅内动脉狭窄患者进行扫描。结果3例患者因躁动及幽闭恐惧等原因无法完成扫描,其余34例患者正常完成扫描,可以有效的显示颅内动脉狭窄的程度及原因。结论应用3.0T 磁共振高分辨率扫描技术,可以明确显示颅内动脉狭窄的程度及原因,提供更有意义的诊断信息。     

高分辨率磁共振成像管壁成像技术在颅内动脉粥样硬化斑块中的诊断价值

目的探讨高分辨率磁共振成像(MRI)管壁成像技术在颅内动脉粥样硬化斑块中的诊断价值。方法回顾性分析213例颅内动脉粥样硬化斑块病变患者的诊疗情况。按照疾病状况,分为急性脑梗死组与短暂性脑缺血发作(TIA)组。比较2组患者斑块分布情况、血管重构方式,对各项检验指标进行受试者工作特征曲线(ROC)分析。结果急性脑梗死组患者腹侧壁、上侧壁斑块分布人数比例显著高于TIA组(P 0. 05)。急性脑梗死组患者背侧壁、下侧壁斑块分布人数比例显著低于TIA组患者(P 0. 05)。急性脑梗死组患者血管正性重构比例显著高于TIA组患者(P 0. 05),负性重构及无重构比例显著低于TIA组(P 0. 05)。在急性脑梗死诊断方面,斑块负荷百分比、狭窄率、斑块面积(PA)、管腔最窄处血管面积(WA_(MLN))及管腔最窄处管腔面积(LA_(MLN))均有一定准确性与敏感性,其中WA_(MLN)有着最优的诊断能力,最优截止数值为9. 50 mm~2,特异性与灵敏度分别为63. 00%与86. 70%。结论高分辨率MRI管壁成像技术在颅内动脉粥样硬化斑块诊断中有较高的价值。     

MRI in Lower Extremity Peripheral Arterial Disease: Recent Advancements

Evaluation of peripheral arterial disease by cardiovascular magnetic resonance imaging continues to develop. Of the clinical diagnostics tests currently available, magnetic resonance angiography is well established as one of the preferred techniques for determining areas of arterial occlusive disease affecting the lower extremities. Despite this, there have been new developments in non-gadolinium based contrast-enhanced studies as well as testing done at higher field strength scanners. In the research arena, magnetic resonance spectroscopy, calf muscle perfusion imaging and atherosclerotic plaque evaluation all have made significant advancements over the last year. These techniques are gaining traction as surrogate endpoints in clinical trials of novel therapeutics aimed at alleviating symptoms in patients with peripheral arterial disease.     

Magnetic Resonance Imaging of Carotid Atherosclerosis and the Risk of Stroke

Stroke attributable to carotid atherosclerosis is a leading cause of mortality and morbidity. The clinical management of carotid atherosclerosis presently relies on the degree of stenosis determined by angiography. Degree of stenosis is limited in stratifying patients’ risk of stroke. Advances in magnetic resonance imaging have resulted in the ability to directly assess atherosclerotic plaque components, morphology, and biomechanical stress levels. Components of atherosclerosis, including lipid-rich necrotic core, fibrous cap thickness/disruption, and intraplaque hemorrhage, are promising emerging indicators of stroke. Information beyond luminal stenosis from magnetic resonance imaging may allow for improved detection of patients at risk of stroke from carotid atherosclerosis. We review the recent literature on the relationship of magnetic resonance imaging detected plaque components and cerebrovascular events. Clinical applications of magnetic resonance imaging of carotid plaque components are discussed.     

低场磁共振水成像结合常规磁共振成像在胆道及泌尿系统疾病诊断中的应用

目的评价低场磁共振水成像结合常规磁共振成像（MRI）在胆道及泌尿系统疾病诊断中的临床价值。方法回顾性分析31例临床怀疑患有胆道、泌尿系统疾病患者的低场（0．2T）磁共振胰胆管成像（MRCP）、磁共振尿路成像（MRU）及常规MRI图像。结果低场MRCP、MRU结合常规MRI对胆道、泌尿系统性疾病的定位诊断符合率为100％,定性诊断总符合率为96．5％。结论低场磁共振水成像结合常规MRI在胆道及泌尿系统疾病诊断中的诊断是非常有效和准确的方法。     

DWI在腹部病变中的应用和最新进展

磁共振弥散加权成像(DWI)是利用MRI观察活体组织水分子弥散运动最理想且唯一的成像方法。随着磁共振超快速成像序列的开发,使DWI的临床应用也愈加广泛,从中枢神经系统扩展到了其他系统,其中以腹部应用较多。本文着重阐述DWI在腹部病变中的应用和进展。     

Coronary imaging: angiography shows the stenosis,but IVUS,CT, and MRI show the plaque

Angiography is the standard clinical test for advanced coronary artery disease. Tomographic cardiovascular imaging tests, ie, intravascular ultrasonography (IVUS), computed tomography (CT), and magnetic resonance imaging (MRI), can be used to assess atherosclerotic plaques responsible for early, silent disease and may become important tools for early detection and prevention.     

MRI of atherosclerosis: diagnosis and monitoring therapy

Atherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High-resolution magnetic resonance imaging has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality for atherosclerotic disease. Atherosclerosis of the arterial wall of the human carotid, aortic, peripheral and coronary arteries have all been successfully evaluated. In addition, the power of magnetic resonance imaging to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced, and has the potential to change the way atherosclerosis is treated.     

MRI of atherosclerosis: diagnosis and monitoring therapy

Atherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High-resolution magnetic resonance imaging has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality for atherosclerotic disease. Atherosclerosis of the arterial wall of the human carotid, aortic, peripheral and coronary arteries have all been successfully evaluated. In addition, the power of magnetic resonance imaging to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced, and has the potential to change the way atherosclerosis is treated.     

MR心肌延迟增强扫描在常见非缺血性心脏病中初步应用

目的研究常见非缺血性心脏病患者心肌病变的磁共振心肌延迟强化的影像学特征。方法回顾性分析25例非缺血性心脏病患者的磁共振心肌延迟强化特点及相应临床表现。结果 25例患者中9例患者心肌病变未出现延迟强化。6例为病毒性心肌炎,4例出现左室后壁、下壁心外膜下心肌可见斑片状延迟强化,1例室间隔部出现散在线状强化;6例为肥厚性心肌病,4例出现室间隔及左室壁出现延迟强化,表现为片状强化;12例为扩张性心肌病,4例在左心室间隔壁、侧壁可见线样强化,左室后下壁、前间隔壁各1例可见小片状强化,以心肌中层及外膜下心肌为主。1例为致心律失常型右室心肌病,延迟强化提示右室下壁及前壁可见片状强化。结论非缺血性心脏病患者心肌病变的磁共振心肌延迟强化具有一定特征,鉴别非缺血性心脏病的病因有赖于密切结合临床病史。     

Impact of plaque characterization on carotid interventions

Plaque characterization is the first step in a process that will help guide physicians to select patients with atherosclerotic carotid disease that is at risk for subsequent neurologic sequelae. Multiple imaging modalities are undergoing investigation, with B-mode ultrasonography and magnetic resonance imaging showing the most promise for clinical applicability in the near future. These techniques provide excellent characterization of plaque components and appear to correlate with findings at the time of carotid interventions. Magnetic resonance findings may additionally predict transition of asymptomatic carotid plaques into symptomatic lesions. Computed tomography imaging as currently performed does not appear to evaluate plaque components adequately. Whether knowledge of plaque characteristics can be used to impact procedural outcomes remains speculative.