永存颈内-基底动脉吻合的影像学特点及其意义

目的　探讨永存颈内-基底动脉吻合的影像学特点, 提高对此类异常吻合血管的认识。 方法　回顾性分析12例经头颈CT血管造影(CTA)及MR血管造影(MRA)诊断为永存颈内-基底动脉吻合患者的影像学资料。其中9例病人行头颈联合CTA检查,3例行头和/或颈部MR血管造影(MRA)检查。 结果　12例中,9例为永存三叉动脉,3例为永存舌下动脉。永存三叉动脉中,外侧型8例,内侧型1例;按Saltzman分型Ⅰ型3例,Ⅱ型2例,Ⅲ型4例;吻合点近端的基底动脉及双侧椎动脉发育不良4例,吻合点近端基底动脉完全萎缩1例;1例合并动脉瘤,2例合并大脑中动脉成窗。3例永存舌下动脉中,2例伴同侧椎动脉缺如,1例伴对侧椎动脉发育不良,1例伴对侧椎动脉发育不良及成窗变异。 结论　（1）CTA及MRA能清晰、快速、准确地显示永存三叉动脉和永存舌下动脉等颈内-基底动脉吻合的走行、毗邻关系及其合并症;（2）熟悉这些原始吻合血管的特征有助于指导临床制定合理的治疗方案,提高相应治疗中的安全性。     

320排容积CTA对颅内动脉瘤的诊断价值

目的探讨320排容积cT血管成像（CTA）对颅内动脉瘤诊断价值。方法选取医院2010年2月-2013年12月间具有完整颅脑数字减影血管造影（DSA）资料的63例颅内动脉瘤患者,所有患者均于起病3d内完成320排容积CTA检查。以DSA检查结果作为诊断金标准,分析病变的影像学特点,并评价320排容积CTA对颅内动脉瘤诊断的准确性。结果颅脑动脉瘤阳性63例,CTA漏诊1例,病灶位于大脑后交通动脉。320排容积CTA对颅内动脉瘤的诊断敏感度及阳性预测值分别为98．41％、100％。按部位统计动脉瘤数量结果如下：颈内动脉海绵窦段4例,大脑前动脉26例,大脑中动脉4例,大脑后动脉8例,大脑前交通动脉10例,大脑后交通动脉5例,基底动脉6例。动脉瘤瘤径为2～22mm。在CTA上,动脉瘤的瘤体位置、大小、瘤颈、瘤顶指向、载瘤动脉及动脉瘤与邻近血管分支和骨性结构的空间关系均能较满意的显示,均与DSA结果相符。结论320排容积CTA诊断颅脑动脉瘤具有较高敏感性,能准确检出颅内的微小动脉瘤,对动脉瘤的空间解剖关系显示更具优势。因此,在临床工作中,320排容积CTA可以成为颅脑动脉瘤的首选影像学检查方法。     

有孔型椎基底动脉的磁共振增强血管成像研究简

目的分析有孔型椎基底动脉的磁共振增强血管成像（CEMRA）的影像学表现及相关血管性病变,提高对该血管异常影像学特征的认识。方法收集自2013年2月至2013年10月635例行头颈部CEMRA检查患者.其中男性337例,女性298例;年龄23～97岁,平均年龄62.4岁。将其图像传人工作站Volumeview软件行后处理,进行最大信号强度投影（MIP）.对图像进行分析。结果有孔型椎基底动脉共22例,其中有孔型基底动脉18例（检出率2.83％）,有孔型椎动脉4例（检出率0.63％）。有孔型椎基底动脉的异常血管形成圆孔状、裂隙样或凸透镜样形态。22例有孔型椎基底动脉中5例有孔基底动脉可见小脑下前动脉（AICA）开口于有孔血管。1例伴有烟雾病,1例合并前交通动脉瘤伴颅内出血,13例同时伴有动脉粥样硬化。结论颅内有孔型椎基底动脉的检出率约3.46％,有孔型血管尚可合并动脉瘤等其他血管性病变.CEMRA结合常规扫描能清楚显示和诊断有孔型椎基底动脉这一少见的血管异常。     

3D—CTA与3D—DSA对颅内后循环动脉瘤影像诊断的比较研究

目的比较三维螺旋CT血管造影术（3D—CTA）和三维数字减影血管造影术（3D—DSA）在颅内后循环动脉瘤诊断及介入治疗中的应用价值。方法选择天津市环湖医院2007年1月至2008年3月就诊的后循环动脉瘤所致的自发性蛛网膜下腔出血（SAH）患者164例,其中男性26例,女性138例,年龄21～80岁,平均年龄53．4岁。行3D—CTA、3D—DSA检查,研究并比较它们的CTA和DSA影像特点。结果164例后循环动脉瘤患者中共213个病灶,其中后交通动脉瘤115个,小脑后下动脉瘤19个,椎基底交界及基底动脉瘤18个,椎动脉颅内段动脉瘤9个,大脑后动脉瘤3个,小脑上动脉和小脑前下动脉瘤各2个。3D—DSA与3D—CTA准确性比较,差异无统计学意义。结论对动脉瘤应用血管内栓塞治疗时,在三维影像指导下可提高动脉瘤的致密填塞率。但是在三维影像的测量值要大于二维影像的测量值。     

双椎动脉变异的影像学特点及临床意义-附3例报道

报道经血管造影证实的3例双椎动脉变异病例:2例为颅外段的椎动脉开窗畸形,其中1例伴有大脑中动脉分叉处动脉瘤,1例左椎动脉起于主动脉弓的变异;另1例为右侧椎动脉双起源变异,伴旁路血管内血栓形成。结合文献对这一现象的胚胎成因及临床意义进行了讨论。     

十六排螺旋CT血管造影在颅内疾病中应用初探

脑血管疾病是危及人体生命的危险疾病.传统的血管造影虽然是诊断该类疾病的最佳方法,但属于有创伤检查,且有1.5%-2.0%的合并症或死亡危险的报导[1].CT血管造影(computed tomographic angiography CTA)的应用给传统的血管造影带来了极大的挑战.1998年问世的多层螺旋CT(MSCT)以亚秒级的扫描速度具有更长的解剖覆盖、更薄的层厚、多种后处理能力、更简单方便等优势.2002年7月,我院引进GE 公司Lightspeed 十六排螺旋CT机,并进行了几十例颅内CTA检查,现对其应用情况进行分析.目的:初讨十六排螺旋CT血管造影在颅内病变中的应用及其技术优势.材料与方法:使用GE 公司的十六排螺旋CT对自发性脑内出血、动脉瘤、脑肿瘤等几十例病人进行CTA检查,对血管显示情况进行评价;其中AVM和动脉瘤进行DSA检查并与CTA结果比较;另外颜面部AVM及脑肿瘤病人与手术结果比较.结果:CTA检查结果如下,脑血管主干及其1-3级分支显示率为100%,大脑中动脉4-5级分支显示率为94.7%.发现动脉瘤并清晰显示了瘤体、瘤颈、载瘤动脉及其详细关系;AVM清楚地显示了AVM的畸形团及其供血动脉和引流静脉;脑肿瘤显示了肿瘤与周围血管、颅骨间的三维关系.结论:十六排螺旋CT血管造影重建图像质量显著提高,它对颅内各种血管性病变以及血管与颅内其他病变三维空间关系,对各类疾病的诊断具有重要价值,它能显示更细小分支,具备作为动脉瘤等其他血管性病变筛选的首选方法.     

椎动脉起始段多层 CT 血管造影与DSA对照研究

目的 本研究的目的是评价 CTA 显示椎动脉第一段(V1) 血管硬化等病变及血管走行的准确性.方法 我们对临床诊断为椎基动脉供血不足的病人的64根椎动脉流入口及V1段进行CTA检查,其中26根椎动脉进行了DSA检查,记录其钙化、狭窄及解剖变异等表现,并对CTA和DSA的检查结果 进行比较.结果 CTA能显示所有病例椎动脉的流入口,DSA检查显示了26 根血管中的21根椎动脉流入口,另5根椎动脉开口显示不清.CTA显示有22根血管开13狭窄,36根椎动脉V1段延长迂曲.DSA 诊断的开口狭窄在CTA检查中都能清晰显示,但有3根椎动脉CTA显示了狭窄,而DSA未能充分暴露椎动脉狭窄段.结论 椎动脉CTA检查对椎动脉开口及起始段的显示明显优于椎动脉DSA,又有安全、便宜、方便的特点,可以大范围推广应用.     

多排CT血管成像显示脑循环血管变异研究进展

目的:探讨多排CT血管成像(MD-CTA)显示脑循环血管变异的价值.方法:查阅国内外相关文献,对各种脑循环血管变异影像学表现、发生率及临床意义进行总结分析.结果:脑循环血管变异包括:颅内动脉开窗和重复、Willis环变异、永存颈动脉-基底动脉吻合、颅底部动脉变异等.有些与动脉瘤形成有关,具有重要临床意义.结论:MD-CTA可检出大多数脑循环血管变异,有利于颅内动脉瘤、脑出血的检查和治疗计划的制定.     

脑血管介入中的血管变异及其临床意义

目的：通过血管介入法,观察脑动脉及其相关血管的变异类型,为临床神经介入手术提供参考依据。方法：对1090例脑血管病患者,常规行全脑四血管造影检查,分析总结常见血管解剖变异。结果：1090例患者中,发现主动脉弓上分支血管变异353处（32.39%）;其中头臂干迂曲常见,占65.72%（232/353）,其次为头臂干与左颈总动脉共干发出16.43%（58/353）和左颈总动脉自头臂干发出11.05%（39/353）。后交通动脉自颈内动脉发出处呈“漏斗”样扩张占23.32%（128/549）和大脑前动脉A1段发育低下或缺如占27.68%（152/549）。小脑后下动脉发自枕大孔下方（椎动脉颅外段）占35.33%（124/351）。结论：主动脉弓上分支、颈内动脉和椎-基底动脉系统存在着多种血管解剖变异。本研究对提高脑血管介入手术成功率和诊疗效果有重要参考价值。     

有孔型椎基底动脉的磁共振增强血管成像研究

目的分析有孔型椎基底动脉的磁共振增强血管成像(CE MRA)的影像学表现及相关血管性病变,提高对该血管异常影像学特征的认识。方法收集自2013年2月至2013年10月635例行头颈部CEMRA检查患者,其中男性337例,女性298例;年龄23~97岁,平均年龄62.4岁。将其图像传入工作站Volumeview软件行后处理,进行最大信号强度投影(MIP),对图像进行分析。结果有孔型椎基底动脉共22例,其中有孔型基底动脉18例(检出率2.83%),有孔型椎动脉4例(检出率0.63%)。有孔型椎基底动脉的异常血管形成圆孔状、裂隙样或凸透镜样形态。22例有孔型椎基底动脉中5例有孔基底动脉可见小脑下前动脉(AICA)开口于有孔血管,1例伴有烟雾病,1例合并前交通动脉瘤伴颅内出血,13例同时伴有动脉粥样硬化。结论颅内有孔型椎基底动脉的检出率约3.46%,有孔型血管尚可合并动脉瘤等其他血管性病变,CE MRA结合常规扫描能清楚显示和诊断有孔型椎基底动脉这一少见的血管异常。     

On the fenestration of the vertebral and basilar arteries]

The fenestration of the vertebral and basilar arteries was investigated macroscopically in 370 human cases. Altogether 43 fenestrations were found in 32 (8.6%) out of 370 cases. The fenestrations could be divided in three groups according to the position where the fenestration appeared. Group I was the fenestration observed along the vertebral artery (Fig. 1), and 7 such fenestrations were found in 6 (1.6%) out of 370 cases; 3 fenestrations among them were located on the right side, 2 were located on the left side and 1 was found on the bilateral vertebral arteries. In 4 out of 7 fenestrations in this group, the hypoglossal nerve was found passing through the fenestration. Group II was the fenestration observed along the basilar artery (Fig. 2), and 26 fenestrations of this type were found in 20 (5.4%) out of 370 cases: 23 fenestrations (88.5%) were located at the caudal half, 3 (11.5%) were located on the rostral half of the basilar artery (Fig. 5). A close relation was indicated between the side on which the fenestration appeared in the basilar artery and the largeness in caliber of the vertebral artery of either side. Group III was the fenestration observed at the lateral area of the vertebral and basilar arteries (Fig. 3), and 10 fenestrations of this type were found in 9 (2.4%) out of 370 cases; all the fenestrations were located on the right side. In this group, the hypoglossal nerve was observed passing through the fenestratin in 4 out of the 10 fenestrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

椎动脉颅内段重复变异MR血管成像的观察分析

目的:探讨椎动脉颅内段重复变异的发生率、磁共振血管成像（MRA）表现特点及其临床意义。方法:回顾性研究。纳入2011年1月—2020年12月聊城市人民医院38 503例患者和体检者的头颈联合或颅脑三维（3D）时间飞跃法（TOF）MRA扫描及最大密度重建（MIP）资料,其中男21 048例、女17 455 例,年龄2～9...     

Intracranial arterial fenestrations: frequency on CT angiography and association with other vascular lesions

Fenestrations (segmental duplications) of the intracranial arteries are rare anomalies, felt to result from incomplete fusion of primitive embryologic vessels. They have been associated with aneurysms and other vascular lesions. The rate of fenestrations based on published angiographic series has been much lower than that at cadaveric series. The purpose of this study is to determine the frequency of fenestrations and associated vascular lesions at CTA. A total of 504 sequential CTA studies from 2005 to 2006 were retrospectively reviewed for the presence of fenestrations, aneurysms and other vascular lesions. Fenestrations were present in 53 patients (11%). Their frequency was not significantly different in patients referred for aneurysm indications, when compared to those referred for non-aneurysm indications. As expected, there was a much higher frequency of aneurysms in the former group. Associated vascular lesions were relatively uncommon. Aneurysms were present at the fenestration site in three patients, and remote from the fenestration site in eight. One fenestration patient with an associated aneurysm at the fenestration site also had an AVM remote from the fenestration. The frequency of fenestrations in this study was higher than in previously published radiologic studies, suggesting that fenestrations are relatively common, and may be more frequently visualized using cross-sectional imaging. Association with aneurysms and other vascular lesions was relatively uncommon. Our results do not support the theory that fenestrations predispose a patient to aneurysms or vascular malformations remote from the site of the fenestration. Although the association of aneurysms at the site of fenestrations is well documented, our results do not show an overall higher rate of aneurysm formation in patients with fenestrations compared to those without.     

椎动脉狭窄临床病例介入治疗前后椎基底动脉血流状况分析

目的:基于血液和弹性血管壁相互作用的流固耦合方法,探究1例椎动脉颅内段狭窄的临床病例支架植入前后椎基底动脉的血流动力学特性。方法:应用医学建模软件对二维CT数据进行三维重建,得到支架植入前后的椎基底动脉血管模型,采用流固耦合方法对支架植入前后的椎基底动脉血流特性进行数值模拟,分析椎基底动脉的血流动力学特性。结果:支架植入前后椎基底动脉的血液流场、血液压力、血管壁面切应力以及管壁形变量有显著的变化。在支架植入后,基底动脉中间部位两侧受力变得均匀,椎基底动脉内血流速度明显增大,支架植入处压力增大,支架上游压力和支架处切应力减小。结论:在介入治疗后,椎基底动脉内的血流环境及受力情况得到明显改善,当椎动脉发生狭窄后应及时干预治疗,避免累及基底动脉和后循环系统。     

Persistent carotid-vertebral anastomosis associated with contralateral accessory middle cerebral artery

An exceptional case is reported of a complex anomaly of the brain arteries including low left carotid bifurcation, persistent carotid-vertebral anastomosis on the left and accessory middle cerebral artery on the right; the whole posterior circulation was only filled through the anomalous anastomotic vessel which joined with the vertebral artery because of a contralateral hypoplasic vertebral artery and the absence of both posterior communicating arteries. This association has not been previously reported in the literature. The embryological processes leading to these arterial anomalies are discussed. Risks related to a severe carotid stenosis or occlusion and to surgical or endovascular procedures in patients harboring these arterial anomalies are emphasized.     

Reactivity of Rat Basilar Artery to Serotonin after Short-Term Ischemia of Hindbrain and during Chronic Vertebrobasilar Insufficiency

Contractile responses of the basilar artery to serotonin were examined in vitro on two models of circulation disturbances in the vertebrobasilar region of the brain. Two days after 30-min reversible occlusion of vertebral arteries, the sensitivity of the basilar artery to serotonin decreased, while chronic vertebrobasilar insufficiency had no effect on serotonin-induced contraction.__________Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 139, No. 4, pp. 399–402, April, 2005     

大鼠椎动脉基底动脉系脑血管神经肽Y能神经与星状神经节、颈上神经节的关系

应用免疫组织化学技术 ABC法和神经节切除术 ,观察了大鼠脑底血管椎动脉、基底动脉系主要动脉分支神经肽 Y能神经纤维的起始核团。正常组大鼠脑底血管椎动脉颅内段、基底动脉和小脑上动脉均可见棕褐色的神经肽 Y能免疫反应阳性纤维 ,呈细线状 ,攀附于血管壁上。手术 I组作左侧星状神经节切除术 ,术后存活 7～ 10 d,左侧椎动脉颅内段阳性纤维基本消失 ,基底动脉和双侧小脑上动脉阳性纤维明显减少 ;右侧椎动脉颅内段阳性纤维无减少。手术 II组作双侧星状神经节切除术 ,双侧椎动脉颅内段、基底动脉和小脑上动脉阳性纤维基本消失。手术 III组作左侧颈上神经节切除术 ;手术 IV组作双侧颈上神经节切除术 ,上述各动脉阳性纤维密度未发现减少现象。手术 I、II组各组纤维密度数据与正常组者比较进行了统计学分析 ,P<0 .0 5。结果提示 :大鼠一侧星状神经节发出的神经肽 Y能神经纤维分布于同侧椎动脉颅内段、基底动脉和双侧小脑上动脉 ,即大鼠脑血管椎 -基底动脉系神经肽 Y能神经纤维主要起源于星状神经节 ,而与颈上神经节关系不大