基于高分辨率MRI评估头颈动脉夹层与急性缺血性脑卒中的关系

目的 基于高分辨率磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)探讨头颈动脉夹层(cervicocranial artery dissection,CCAD)致急性缺血性脑卒中的影响因素。材料与方法 回顾性分析经临床确诊的73例CCAD患者病例,根据其弥散加权成像(diffusion weighted imaging,DWI)明显高信号分为卒中组与非卒中组,收集临床和影像学资料,采用单因素和多因素Logistic回归方法分析CCAD与急性缺血性卒中的关系。结果 共73例CCAD患者、85条夹层血管纳入研究,其中卒中组45例,54条夹层血管;非卒中组28例,31条夹层血管。卒中组高血压患病率[34 (75.56%)]高于非卒中组[11 (39.29%)],差异具有统计学意义(P=0.002)。多因素Logistic回归分析显示,两组之间高血压、管腔轻度狭窄、管腔重度狭窄、管腔闭塞、内膜瓣、夹层动脉瘤差异均具有统计学意义(P均<0.05),高血压、管腔重度狭窄、管腔闭塞、内膜瓣与急性缺血性脑卒中显著相关(OR分别为4....     

11例颈部动脉夹层致缺血性脑卒中支架治疗的护理

通过对12例颈部动脉夹层致缺血性脑卒中患者进行支架置入治疗,并对患者行术前、术后护理及术中配合。11例患者支架成功置入,术中、术后无并发症发生,1例患者由于血管因素未能完成。     

复发急性缺血性脑卒中患者大脑中动脉斑块的高分辨率MRI研究

目的利用3.0 T高分辨磁共振(HR-MRI)研究复发急性缺血性脑卒中患者大脑中动脉斑块形态特征。材料与方法回顾性分析77例责任血管为大脑中动脉的急性缺血性脑卒中患者资料,其中初发患者36例(初发组),复发患者41例(复发组),所有患者均行3.0 T高分辨磁共振斑块成像(扫描序列包括TOF-MRA,头颅常规DWI,责任血管轴位T1WI、T2WI及T1WIGd-DTPA增强)。对比分析初发组与复发组急性缺血性脑卒中患者责任血管管腔狭窄率、最小管腔面积、斑块负荷、斑块强化率、T1WI及T2WI斑块信号强度指数。结果复发组患者大脑中动脉管腔狭窄率(P=0.002)、斑块负荷(P=0.005)、斑块强化率(P=0.037)均明显高于初发组,最小管腔面积(P=0.001)明显小于初发组。复发组斑块T2WI信号强度指数大于初发组(P0.001),而T1WI信号强度指数两者无明显差异(P=0.245)。结论高分辨率磁共振可以有效评估复发急性缺血性脑卒中患者大脑中动脉斑块的形态特征,综合评价斑块特征可为临床提供参考以助于预防脑卒中复发。     

基底动脉夹层动脉瘤的磁共振血管壁成像表现

目的总结分析基底动脉夹层动脉瘤的MR血管壁成像表现特点。材料与方法 27例经临床证实的基底动脉夹层动脉瘤病例,对基底动脉夹层动脉瘤的磁共振血管壁成像表现特点进行总结分析。结果基底动脉夹层动脉瘤影像征象包括血管迂曲扩张、内膜征、双腔征、壁内血肿、长段不规则或丝线样狭窄、鼠尾状闭塞。结论对于基底动脉夹层动脉瘤患者,行基底动脉磁共振血管壁成像能够清晰显示血管迂曲扩张、内膜征、双腔征、壁内血肿、长段不规则或丝线样狭窄、鼠尾状闭塞异常,是基底动脉夹层动脉瘤的一种有效准确的检查方法。     

颈部动脉夹层的超声影像特征分析

目的总结颈部动脉夹层的超声影像特征,以期提高超声对其的诊断准确率。方法选取18例经DSA、CTA或MRI证实的颈动脉夹层患者,回顾性分析其超声影像资料,总结其超声影像特征。结果 18例颈部动脉夹层患者共21根血管,超声准确诊断13例共15根血管,准确率71%。13例患者15根血管超声表现为"双腔征"(真腔和假腔),血管腔内见膜带状回声;3例患者4根血管超声表现为锥形不规则狭窄,疑为动脉夹层;2例患者2根血管超声表现为动脉管腔远端充满低回声,未见血流充盈,诊断为闭塞。结论颈部动脉夹层的超声特征具有一定特异性,超声可作为其首选检查方法。     

高尿酸血症与缺血性脑卒中患者颈部动脉斑块及狭窄的关系

目的探讨高尿酸血症与缺血性脑卒中颈部动脉宽块之间的关系,为缺血性脑卒中的治疗提供参考方向。方法选取深圳市第六人民医院2005年1月至2008年12月缺血性脑卒中伴血尿酸升高的60例患者为研究组,并选取同期单纯缺血性脑卒中的140例患者为对照组,观察两组患者颈部动脉斑块与狭窄的情况。结果研究组颈部动脉斑块及狭窄Ⅲ级、Ⅳ级均明显高于对照组（P〈0．05）;研究组血尿酸水平高于对照组（P〈0．05）。随着颈部动脉斑块及狭窄程度的增加,患者血尿酸水平也不断升高（P〈0．05）。内中膜厚度大于或等于1．0mm患者的血尿酸水平明显高于内中膜厚度小于110mm的患者（t=11．414,P〈0．05）。结论缺血性脑卒中颈部动脉斑块、狭窄及颈动脉内中膜厚度与高尿酸血症直接有着密切的联系,并且在某种程度上血尿酸的水平能够反映出颈部动脉斑块及狭窄程度。     

集合磁共振成像对急性缺血性脑卒中动脉闭塞后侧支动脉显示效果及图像质量的比较

目的 比较使用集合磁共振成像(SyMRI)技术与MRI传统序列对慢性大脑中动脉闭塞引起急性缺血性脑卒中的动脉闭塞的侧支动脉显示效果及图像质量,分析两者的优劣性。方法 回顾性分析67例慢性大脑中动脉闭塞引起的急性缺血性脑卒中患者的MRI检查结果,其中MRI常规序列包括T₂加权像(T₂WI)、T₁液体衰减反转恢复(FLAIR)、T₂ FLAIR、时间飞跃法磁共振血管成像(TOF-MRA),SyMRI技术包括MAGiC序列,采用配对Kolmogorov-Smirnov检验对比分析TOF-MRA和MAGiC相位敏感反转恢复(PSIR)Vessel对动脉闭塞后侧支动脉显示效果,分析常规序列与SyMRI技术的信噪比(SNR)。由2名放射科医师采用盲法主观分析图像质量,采用Kappa检验分析结果的一致性。结果 MAGiC序列(成像时间247 s)比MRI常规序列(成像时间438 s)的扫描时间缩短51%。动脉闭塞后MAGiC PSIR Vessel比TOF-MRA显示的侧支更多(P <0.001)。MAGi...     

高分辨率磁共振血管壁成像技术在颅内动脉疾病中的研究进展

颅内动脉疾病是导致脑卒中最重要原因之一,其病因众多,早期明确病因对于疾病的治疗极其重要,高分辨率磁共振血管壁成像技术是一种新兴的影像学检查方式,主要用于分析颅内动脉病变,观察动脉斑块及管壁结构,弥补了传统的血管成像技术只显示管腔狭窄程度的不足。高分辨率磁共振血管壁成像技术对颅内动脉粥样硬化、动脉夹层、烟雾病、中枢神经系统血管炎及动脉瘤的诊断及鉴别诊断具有重要意义。本文就高分辨率血管壁成像技术在上述颅内动脉疾病中的应用展开综述。     

MRI联合MRA对急性缺血性脑卒中患者颈动脉狭窄的评估分析

目的:探讨分析磁共振成像(MRI)联合磁共振血管成像(MRA)评估急性缺血性脑卒中(AIS)患者颈动脉狭窄的应用价值。方法:本研究采用前瞻性分析方法,纳入2019年1月—2022年2月我院100例AIS患者为研究对象。全部患者均先后接受MRI、MRA检查,并于1周内进行数字减影血管造影(DSA)检查。以DSA检查结果为“金标准”,分析MRI联合MRA评估AIS患者颈动脉狭窄的应用价值。结果:100例患者经DSA结果证实,共有118条颈动脉血管存在狭窄,其中31条轻度狭窄,48条中度狭窄,29条重度狭窄,10条完全闭塞,占比分别为26.27%、40.68%、24.58%、8.47%;MRI、MRA单独和二者联合评估AIS患者颈动脉狭窄的准确性分别为72.88%、85.59%、96.61%,且以二者联合评估的准确性最高,差异有统计学意义(P<0.05);以病理学检查结果作为依据,MRI联合MRA评估纤维帽、脂质核、伴有出血、伴有钙化形成和斑块软硬度的符合率比较,差异无统计学意义(P>0.05)。结论:MRI联合MRA评估AIS患者颈动脉狭窄与DSA结果具有较高的一致性,有一定的...     

高分辨率MR管壁成像评估缺血性脑卒中患者血管斑块稳定性

目的 分析高分辨率MR管壁成像（HR-VWI）评估不同亚型缺血性脑卒中患者血管斑块稳定性的价值。方法 回顾性分析43例临床诊断缺血性脑卒中患者的MR HR-VWI资料,包括15例载体动脉（斑块或血栓）阻塞穿支（PAOPA）（PAOPA组）,22例动脉到动脉栓塞（ATAE）（ATAE组）,3例低灌注/栓子清除下降（HP/IEC）及3例混合机制（MM）。比较PAOPA组与ATAE组责任斑块形态、分布、位置及管腔表现的差异。结果 PAOPA组与ATAE组间责任斑块分布差异无统计学意义（χ²=12.16,P>0.05）。ATAE组责任斑块表面不规则发生率（63.64%）及斑块负荷[（70.39±11.27）%]均高于PAOPA组[26.67%,（63.11±10.57）%,χ²=8.87,t=4.02,P=0.04、0.03]。ATAE组斑块2级强化发生率（81.82%）高于PAOPA组（26.67%,χ²=7.51,P=0.03）,斑块0级强化发生率（9.09%）低于PAOPA组（46.67%,χ²=8.02,P=0.03）;2组斑块偏心性分布发生率、斑块内T1高信号发生率、斑块厚度、责任斑块处管腔狭窄率及血管重构方式差异均无统计学意义（P均>0.05）。结论 HR-VWI对鉴别不同亚型缺血性脑卒中血管斑块的稳定性具有一定价值;相比PAOPA,ATAE斑块HR-VWI更多表现出不稳定特征。     

自发性头颈动脉夹层HRMRI与缺血性卒中的相关性分析

目的 分析自发性头颈动脉夹层(spontaneous cervicoce-rebral artery dissection,SCAD)在高分辨力磁共振成像(high-resolution magnetic resonance imaging,HRMRI)中的影像学特征与急性缺血性卒中的相关性。 方法 对23例确诊为自发性头颈动脉夹层的患者进行HRMRI检查。排除心源性卒中及图像质量差者。由 2 名放射科医生对HRMRI 影像学特征进行双盲分析,评价内容包括内膜瓣、壁内血肿及夹层动脉瘤等。将每个患者划分为颈动脉系统及椎动脉系统4支血管节段进行观察分析。比较卒中组(发生急性缺血性卒中)和非卒中组(未发生急性缺血性卒中)SCAD患者HRMRI特征差异。 结果 最终21例患者纳入研究。84个血管节段中共诊断27个节段存在动脉夹层,其中累及颈内动脉系统11个节段、椎动脉系统16个节段。27个血管节段中11个节段存在供血区急性缺血性卒中。卒中组的管腔狭窄所占比例(54.5%)较非卒中组(19.2%)大,差异有统计学意义(P＜0.001),卒中组的壁内血肿(72.7%)所占比例较非卒中组(1.4%)大,差异有统计学意义(P＜0.001)。 结论 HRMRI存在管腔狭窄及壁内血肿的SCAD患者更易发生急性缺血性卒中。     

Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular Magnetic resonance study

Background

Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD).

Methods

35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner''s syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images.

Results

The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen''s kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen''s kappa of 0.74 (p < 0.001).

Conclusions

Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.     

B-flow imaging in low cervical internal carotid artery dissection.

OBJECTIVE: Generally, the vascular ultrasonographic examination is the first method in evaluation of internal carotid artery (ICA) dissection. B-flow imaging (BFI), conversely, is a newer method of vascular ultrasonography. The objective of this study was to assess the accuracy and efficacy of BFI for the diagnosis of low cervical ICA dissection. METHODS: Seventeen consecutive patients with 18 angiographically confirmed low cervical ICA dissections and 16 nondissected ICAs were studied with BFI and color Doppler ultrasonography (CDU). The results were compared with those of digital subtraction angiography. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of BFI in diagnosis of low ICA dissection were 94%, 94%, 94%, 94%, and 95%, respectively. Corresponding results for CDU were 83%, 94%, 94%, 83%, and 88%. B-flow imaging more precisely showed the intimal flap and the visualization of flow within the true and false lumens. In dissected carotid arteries, 6 intimal flaps were diagnosed with CDU, and 15 intimal flaps were diagnosed with BFI. The agreement between the observers in determining low cervical ICA dissection by BFI was found to be excellent (kappa = 0.80 for intramural hematoma; kappa = 0.93 for intimal flap). CONCLUSIONS: B-flow imaging seems to be a new reliable vascular ultrasonographic technique for evaluation of low cervical ICA dissection.     

快速波谱成像用于急性缺血性脑卒中

目的评价快速波谱成像(TSI)技术用于急性缺血性脑卒中(AIS)的价值。方法对40例AIS患者行TSI及常规多体素化学位移波谱成像(CSI),采用对应频谱拟合脚本获得N-乙酰天冬氨酸(NAA)、肌酸复合物(Cr)、胆碱复合物(Cho)、乳酸(Lac)峰下面积及NAA、Cho、Lac与Cr的比值;将TSI和CSI拟合后获得的NAA和Lac分布伪彩图分割后与弥散加权成像(DWI)相融合,分析其匹配程度。结果相比周边正常脑组织,梗死边缘区NAA稍降低,梗死核心区NAA降低程度大于梗死边缘区,Lac则呈相反趋势;梗死周边正常脑组织存在少量Lac分布。TSI与CSI数据经拟合的代谢物分布差异无明显统计学意义(P均>0.05)。TSI与CSI分别显示33例及32例NAA伪彩图暗区分布小于DWI高信号区,Lac伪彩图高亮区明显大于DWI高信号区。结论采用TSI可在较短时间内完成采集,并获得与常规CSI基本一致的代谢物分布数据。AIS患者代谢物分布伪彩图可能与DWI高信号区不匹配。     

基于mDixon新型MR血管成像序列用于颈部动脉成像的可行性

目的 基于将放射状k空间填充及压缩感知技术融合于mDixon技术开发一种新型MR血管成像(MRA)序列(3D mDixon-MRA),观察其用于颈部动脉成像的可行性。方法 前瞻性收集45例疑诊颈部动脉疾病患者，以3D时间飞跃法采集颈部动脉MRA(3D TOF-MRA)及3D mDixon-MRA,比较颈总动脉根部和中远段、椎动脉根部和中远段及颈内外动脉根部在2种图像中的信噪比(SNR)和对比度噪声比(CNR),以及2种图像质量主观评分的差异。结果 3D mDixon-MRA所示各动脉SNR均显著高于3D TOF-MRA(P均<0.01)。颈总动脉根部CNR在2种图像中的差异无统计学意义(P=0.13),其余动脉在3D mDixon-MRA中的CNR均显著高于3D TOF-MRA(P均<0.01)。颈总动脉根部、椎动脉根部及椎动脉中远段在3D mDixon-MRA中的主观评分均高于3D TOF-MRA(P均<0.05),其余动脉在2种图像中的主观评分差异均无统计学意义(P均>0.05)。结论 3D mDixon-MRA序列可用于颈部动脉成像，有利于提高图像质量、缩...     

颈动脉蹼的高分辨率磁共振血管壁成像的影像分析

目的探索颈动脉蹼(carotid web,CaW)的高分辨率磁共振血管壁成像(vessel wall magnetic resonance imaging,VW MRI)的信号及形态特点。材料与方法选取经计算机断层扫描血管造影术(computed tomography angiography,CTA)诊断的10例颈动脉蹼的患者,从多序列多方位分析颈动脉蹼磁共振的信号及形态特点。结果颈动脉蹼的磁共振信号特点为T1WI表现为均匀等信号,T2WI表现为稍高信号,抑脂序列信号不减低,增强后明显强化。10例颈动脉蹼患者中出现等信号管壁增厚10例(100%),突向管腔10例(100%),管腔内分隔9例(90%),双腔征8例(80%),瓣膜征6例(60%),对比剂瘀滞3例(30%)。结论颈动脉蹼与既往无明显心血管危险因素患者的缺血性卒中事件具有很高的相关性。VW MRI在颈动脉蹼的影像诊断中具有较高的临床应用价值和特征的影像表现,有利于为颈动脉蹼的未来研究提供参考。     

A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review

Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural haematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger. Headache and/or neck pain is the most common initial symptom of cervical artery dissection. Other symptoms include Horner’s syndrome and lower cranial nerve palsy. Both headache and/or neck pain are common symptoms and leading causes of disability, while cervical artery dissection is rare. Patients often consult their general practitioner for headache and/or neck pain, and because manual-therapy interventions can alleviate headache and/or neck pain, many patients seek manual therapists, such as chiropractors and physiotherapists. Cervical mobilization and manipulation are two interventions that manual therapists use. Both interventions have been suspected of being able to trigger cervical artery dissection as an adverse event. The aim of this review is to provide an updated step-by-step risk–benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.

• Key messages

• Cervical mobilization and/or manipulation have been suspected to be able to trigger cervical artery dissection (CAD). However, these assumptions are based on case studies which are unable to established direct causality.

• The concern relates to the chicken and the egg discussion, i.e. whether the CAD symptoms lead the patient to seek cervical manual-therapy or whether the cervical manual-therapy provoked CAD along with the non-CAD presenting complaint.

• Thus, instead of proving a nearly impossible causality hypothesis, this study provide clinicians with an updated step-by-step risk–benefit assessment strategy tool to (a) facilitate clinicians understanding of CAD, (b) appraise the risk and applicability of cervical manual-therapy, and (c) provide clinicians with adequate tools to better detect and exclude CAD in clinical settings.

     

三维准连续式动脉自旋标记评估单侧大脑中动脉狭窄致急性缺血性脑卒中影像学进展

目的 探讨三维准连续式动脉自旋标记（3D-pcASL）评估单侧大脑中动脉（MCA）狭窄致急性缺血性脑卒中影像学进展的价值。方法 回顾性分析31例单侧MCA狭窄致急性缺血性脑卒中患者的MRI资料。根据入院时及入院7天内全脑DWI表现将患者分为进展组20例及无进展组11例。分别在标记后延迟（PLD）时间为1.5 s 及2.5 s条件下对2组行全脑3D-pcASL扫描,检测2组患侧（MCA狭窄侧）、健侧额叶、顶叶、颞叶、枕叶皮层和前外分水岭区、后外分水岭区、内分水岭区、基底核区侧支循环代偿脑血流量（ΔCBF）值,比较上述ΔCBF值差异。绘制ROC曲线,评价患侧各脑区侧支循环ΔCBF值对单侧MCA狭窄致急性缺血性脑卒中影像学进展的诊断效能。结果 进展组患侧、健侧后外分水岭区侧支循环ΔCBF值均较无进展组相应脑区降低（P均<0.05）。患侧后外分水岭区侧支循环ΔCBF值诊断脑卒中影像学进展的AUC为0.750,敏感度为0.85,特异度为0.64;内分水岭区的AUC为0.709,敏感度为0.95,特异度为0.55。结论 3D-pcASL可评价单侧MAC狭窄致急性缺血性脑卒中患者的侧支循环代偿情况,有助于早期诊断脑卒中影像学进展。     

高分辨率磁共振血管壁成像在颅内动脉粥样硬化性疾病中的应用

高分辨率磁共振血管壁成像（HR-VWI）是一种具有超高分辨率的磁共振成像技术。其抑制血流信号后能清晰显示动脉粥样硬化斑块的纤维帽、脂质核心、壁内血肿及管腔狭窄情况。HR-VWI能为临床诊疗提供关键影像学信息,在动脉粥样硬化性心脑血管疾病中具有重要诊断价值。本文就HR-VWI成像原理及其在颅内动脉粥样硬化性疾病的评估、在颅内动脉夹层及动脉瘤中的应用价值、在症状性非狭窄性颅内动脉粥样硬化性疾病中的应用、在脑小动脉病变及腔隙性脑梗死中的应用与动脉粥样硬化性疾病的科学研究等方面进行综述。