烟雾病磁共振成像和血管成像表现

目的：分析和讨论烟雾病的ＭＲＩ和ＭＲＡ表现及其诊断意义。材料和方法：对１５例烟雾病患者进行了ＭＲＩ检查，其中１４例同时进行了ＭＲＡ检查。结果：烟雾病ＭＲＩ表现为闭塞血管流空效应消失，侧支循环血管形成，其典型表现为从鞍上向基底节区走行的条状迂曲低信号（７／１５），以及由于缺血和出血引起的改变，包括多发脑梗塞（１１／１５），脑萎缩（７／１５），脑室扩大（４／１５）及脑内血肿和蛛网膜下腔出血（各１例）。ＭＲＡ可直接显示狭窄和闭塞的血管，多表现为多支、双侧血管受累；血管改变有广泛性和局限性两种类型。侧支循环血管表现为基底节区团状模糊血管，呈烟雾状（８／１４）。结论：ＭＲＩ和ＭＲＡ可以显示烟雾病的脑内病理和血管改变，为该病提供了一种安全、准确的诊断方法。     

烟雾病的MRI和MRA诊断

分析和讨论烟雾病的ＭＲＩ和ＭＲＡ表现及其诊断意义。材料和方法：对９例烟雾病患者进行了ＭＲＩ和ＭＲＡ检查,其中２例进行了ＤＳＡ检查。结果：９例ＭＲＩ上,８例显示脑实质改变包括脑梗死５例,脑萎缩２例,脑室扩大１例。８例中４例显示异常血管流空现象。另１例脑内未见异常．ＭＲＡ均良好地显示了病变血管狭窄和闭塞现象,表现为多支、双侧受累,在大脑中动脉为主,与ＤＳＡ所见相仿。结论：ＭＲＩ结合ＭＲＡ可作为烟雾病诊     

蛛网膜下腔出血患者的MRA和DSA的对照研究

目的：研究ＭＲ血管造影（ＭＲＡ）在蛛网膜下腔出血（ＳＡＨ）患者病因诊断中的应用准确性和可靠性。材料和方法：回顾性分析３３例ＳＡＨ患者的ＭＲＡ资料，并与ＤＳＡ作了对比分析，ＭＲＡ采用三维时间流逝（３Ｄ－ＴＯＦ）法。结果：ＭＲＡ上显示了２６例血管病变中的２２例，包括１５个动脉瘤中的１３个，８例动静脉畸形中的６例和３例血管狭窄闭塞性病变。１个完全血栓形成的右颈内动脉瘤ＭＲＡ上未显示。但常规ＭＲＩ和ＭＲＡ原始图像上显示，ＭＲＡ结合ＭＲＩ和ＭＲＡ原始图像可以对９１％的患者做出正确诊断和评价，动脉瘤和周围血管的关系及ＡＶＭ的供血动脉和畸形结节能在ＭＲＡ上被准确评价。结论：作为一种非损伤性的血管成像方法，ＭＲＡ具有安全、可靠和方便的优点，可以做为常规用于ＳＡＨ患者的筛选检查。     

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。     

磁共振脑血管造影与数字减影血管造影的比较

通过对５５例脑血管磁共振血管造影（ＭＲＡ）和动脉数字减影血管造影（ＩＡ－ＤＳＡ）的对比分析，探讨了ＭＲＡ在颅内血管病变诊断中的可靠性。结果表明，ＭＲＡ可以对４８例患者做出正确诊断，结合常规ＭＲＩ和ＭＲＡ原始切层图像，其敏感性为９０．９％。对动脉瘤的敏感性为８７．５％，动静脉畸形为７８．６％。３例血管狭窄闭塞性病变和１例脑膜瘤患者的血管改变也与ＤＳＡ完全符合。可以认为，作为一种常规筛选工具，ＭＲＡ用于脑血管病变的检查和诊断，具有安全、可靠和方便的优点。     

烟雾病的磁共振成像诊断

目的：回顾分析８例烟雾病的磁共振成像表现，探讨磁共振成像对烟雾病的诊断价值。方法：８例烟雾病中男女各４例。年龄４～４９岁，平均２０．４岁。磁共振成像应用Ｓｉｅｍｅｎｓ１．０ＴＭＲ系统和头表面线圈。均有ＳＥ序列Ｔ１ＷＩ和Ｔ２ＷＩ，７例有三维时间飞跃法磁共振血管造影（３Ｄ－ＴＯＦＭＲＡ），１例有ＤＳＡ。结果：ＳＥ序列ＭＲＩ均见丘脑－基底节区（单侧２例，双侧６例）有扩张的烟雾血管，其中以Ｔ１ＷＩ显示更为清楚直观。７例３Ｄ－ＴＯＦＭＲＡ和１例ＤＳＡ均见ＩＣＡ上端、ＭＣＡ和ＡＣＡ近端闭塞以及丘脑－基底节区的烟雾血管。这些病理血管分布侧别与ＳＥ序列磁共振成像所见一致。结论：ＳＥ序列磁共振成像和３Ｄ－ＴＯＦＭＲＡ是诊断烟雾病的有效方法。Ｔ１ＷＩ显示丘脑－基底节区烟雾血管优于Ｔ２ＷＩ。３Ｄ－ＴＯＦＭＲＡ尚适用于烟雾病血管旁路术后随诊及其高危人群普查。     

Budd—Chiari综合征的MRI

目的：探讨Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＭＲＩ和ＭＲＡ表现及其诊断价值。材料和方法：回顾性分析５例经腔静脉造影证实的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征的ＭＲＩ和ＭＲＡ表现,并与腔静脉造影进行比较。结果：ＭＲＩ和ＭＲＡ表现如下：１、肝肿大,３例慢性者尾叶增大;２、肝静脉未显示,肝内血管呈逗点状;３、下腔静脉狭窄、阻塞和狭窄阻塞后扩张及血流信号异常,与腔静脉造影比较,ＭＲＩ和ＭＲＡ显示狭窄和阻塞的形态不够确切;４、肝外侧枝血管形成。结论：ＭＲＩ对Ｂｕｄｄ－Ｃｈｉａｒｉ综合征具有特征性的诊断价值,但不能取代腔静脉造影。     

主动脉夹层几种磁共振影像的评价和比较

目的：评价和比较ＭＲＩＳＥ常规序列、电影（ｃｉｎｅ）ＭＲＩ及ＭＲ血管造影（ＭＲＡ）对主动脉夹层的诊断价值。材料和方法：对２５例主动脉夹层进行了３１人次ＭＲ检查。其中包括胸腹主动脉ＳＥ序列３１人次，胸主动脉ｃｉｎｅＭＲＩ２３人次及腹主动脉二维时间飞跃（２ＤＴＯＦ）ＭＲＡ２１人次。将ｃｉｎｅＭＲＩ及ＭＲＡ分别与其相应ＳＥ序列ＭＲ表现进行比较。结果：胸主动脉ｃｉｎｅＭＲＩ２３例与相应ＳＥ序列比较，两者所有病例均显示内膜片及真假两腔，但显示破口分别为１４和９例。显示头臂血管受累分别为７和２条。腹主动脉ＭＲＡ２１例与相应ＳＥ序列比较，两者均显示内膜片和真假两腔，但显示破口或再破口者分别为４和２例，腹主动脉分支血管受累分别为３９和１４条。结论：ＭＲ是诊断主动脉夹层的最佳影像学方法之一。在常规ＳＥ序列基础上，辅以ｃｉｎｅＭＲＩ和ＭＲＡ技术将大大提高ＭＲ总体观察夹层范围、内膜破口以及分支受累的能力，给临床提供更多的信息。     

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     

下肢动脉慢性闭塞症的MRA诊断

目的：对ＭＲＡ在下肢动脉慢性闭塞症中的诊断价值作一初步评估。材料与方法：５４例下肢动脉慢性闭塞症患者，行二维时间飞跃法ＭＲＡ检查，范围包括主动脉下段、髂动脉、股动脉、动脉及其三分支。其中２１例同时行动脉造影，１８例手术探查。结果：２１例ＭＲＡ与动脉造影对照，可比动脉节段１６８个，其中正常或轻度狭窄４６个节段，中度狭窄２７段，重度狭窄４６段，闭塞４９段，两者符合率为９２．２６％（１５５／１６８）。１８例与手术对照，可比动脉节段８２个，符合率为９２．６８％（７６／８２）。同时进行的２３例双功能多普勒超声测定踝／肱指数显示，踝／肱指数＜０．５，ＭＲＡ显示血管为重度狭窄或闭塞。结论：下肢动脉ＭＲＡ与手术、动脉造影、踝／肱指数比较，具有很好的一致性，能比较准确地评价下肢动脉慢性闭塞性病变，尤其对重度狭窄和闭塞准确性较高。     

磁共振血管成像对烟雾病诊断价值的探讨

目的:探讨MRA和MRI对烟雾病的诊断价值。方法:回顾性分析18例烟雾病MRA和DSA表现,18例中5例同时行DSA,采用2.0T超导高磁场MR扫描仪,MRA采用3D-TOF或3D-PC法。DSA采用GE Advantx心血管造影系统。结果:MRA显示狭窄或闭塞的血管,表现为多支、双侧受累。MRI平扫表现脑基底部狭窄、闭塞血管的流空效应减弱甚至消失,侧支循环血管形成所致的点状、条状迂曲低信号影。8例颅内可见血肿。结论:MRA作为一种无创伤的血管成像技术,能准确诊断moyamoya病可以与DSA媲美,结合MRI平扫可同时显示脑组织病变。     

Moyamoya disease: MR imaging

Eleven patients with moyamoya disease were studied with magnetic resonance (MR) imaging performed with a high-field-strength (1.5-T) superconducting magnet. In all cases a fundamental pathologic change of moyamoya disease--occlusion or stenosis of the terminal portion of the internal carotid artery and the proximal portion of anterior and middle cerebral arteries--was clearly demonstrated. The characteristic collateral network from the suprasellar cistern to the basal ganglia, which corresponds to the "moyamoya vessels" on angiograms, was seen in several patients. Various ischemic changes, including infarction, brain atrophy, and ventricular dilatation, were also well demonstrated. MR imaging plays an important role in the diagnosis of moyamoya disease.     

Leptomeningeal high signal intensity (ivy sign) on fluid-attenuated inversion-recovery (FLAIR) MR images in moyamoya disease

PURPOSE: There are a few reports on leptomeningeal high signal intensity (LMHI: ivy sign) on fluid-attenuated inversion-recovery (FLAIR) images in moyamoya disease, but the feature of this finding has not been completely understood. The purpose of this study was to characterize LMHI on FLAIR images in moyamoya disease and to assess usefulness of this finding in the diagnosis of moyamoya disease in conventional MR imaging. MATERIAL AND METHODS: MR imaging of 28 patients with moyamoya disease was retrospectively reviewed. The grade of LMHI on FLAIR images was classified as "absent," "minimal," "moderate" and "marked." Fifty-four hemispheres of 28 patients (2 patients had unilateral disease) were assessed for the frequency of visualization and distribution of LMHI. The correlations between LMHI on FLAIR images, moyamoya vessels on T1- and T2-weighted images and MR angiography findings were also analyzed. RESULTS: Moderate and marked LMHI was seen in 31 out of 54 hemispheres (57%). LMHI was seen more prominently in the frontal and parietal lobes than in the temporal and occipital lobes. Although there was a tendency for LMHI on FLAIR images to be prominent in groups with moderate and marked moyamoya vessels on T1- and T2-weighted images, there was no significant correlation. More prominent LMHI was observed in the hemispheres in which cortical branches of the middle cerebral arteries were poorly visualized on MR angiography. CONCLUSION: Leptomeningeal high signal intensity (ivy sign) on FLAIR images is predominantly seen in the frontal and parietal lobes. Because this sign can be seen in patients with unremarkable moyamoya vessels, LMHI is a useful sign in conventional MR imaging for the diagnosis of moyamoya disease.     

MR angiography of moyamoya disease before and after encephaloduroarteriosynangiosis

OBJECTIVE: Our purpose was to evaluate the usefulness of MR angiography in revealing moyamoya disease before and after encephaloduroarteriosynangiosis. SUBJECTS AND METHODS: Twenty-six patients (51 hemispheres) with angiographically confirmed moyamoya disease who underwent encephaloduroarteriosynangiosis were included in the study. Findings on preoperative MR angiography were compared with those on conventional angiography. Postoperative neurologic status was categorized as poor, fair, good, or excellent. Postoperative MR angiography was examined for the appearance of the superficial temporal artery, changes in moyamoya vessels, and transdural collateral vessels into the middle cerebral artery territory. RESULTS: Preoperative MR angiography revealed moyamoya disease in all patients (diagnostic accuracy, 100%). MR angiography correctly depicted the degree of internal carotid artery stenosis in 37 arteries (73%), moyamoya vessels in 33 hemispheres (65%), and the degree of stenosis in the middle, anterior, and posterior cerebral arteries in 125 (82%) of 153 arteries. After surgery, 39 hemispheres showed an excellent outcome, eight showed a good outcome, two a fair outcome, and two a poor outcome. On postoperative MR angiography, vascular supply to the middle cerebral artery territory via transdural collateral vessels increased in 28 hemispheres (55%) and decreased in four (8%). The size of the superficial temporal artery increased in 41 (80%) of 51 hemispheres. The extent of moyamoya vessels decreased in 27 hemispheres (53%) after surgery. CONCLUSION: MR angiography can show the changes in the superficial temporal artery and development of transdural collateral vessels after encephaloduroarteriosynangiosis. Because MR angiography is noninvasive, it is valuable for evaluating postoperative changes.     

Comparison of 3.0- and 1.5-T three-dimensional time-of-flight MR angiography in moyamoya disease: preliminary experience

PURPOSE: To prospectively compare 3.0- and 1.5-T three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography in patients with moyamoya disease, with special emphasis on the visualization of abnormal netlike vessels (moyamoya vessels). MATERIALS AND METHODS: Study protocols were approved by the local ethics committee; written informed consent was obtained from all patients. The study included 24 consecutive patients with moyamoya disease (four male and 20 female patients). Patients ranged in age from 17 to 66 years (mean age, 41 years). Moyamoya disease had been diagnosed in all patients before they were entered into the study. All patients underwent 3D TOF MR angiography at both 3.0 and 1.5 T; imaging examinations were performed within 14 days of each other. Maximum intensity projections (MIPs) obtained with MR angiography performed at both 3.0 and 1.5 T were evaluated by two neuroradiologists; the visualization of moyamoya vessels was graded according to a 4-point scale. For both 3.0- and 1.5-T imaging, the number of high-signal-intensity areas and the summation of cross-sectional areas of high signal intensity on source images obtained at the same level of MR angiography were compared quantitatively by using the Wilcoxon matched-pair signed-rank test. RESULTS: Moyamoya vessels were better visualized on MIPs obtained with 3.0-T imaging than on MIPs obtained with 1.5-T imaging (P < .001). At the identical level of the source image, 3.0-T imaging depicted more high-signal-intensity areas than did 1.5-T imaging. Wider cross-sectional areas of moyamoya vessels were visualized with 3.0-T imaging than with 1.5-T imaging (P < .001). CONCLUSION: Moyamoya vessels are better depicted with MR angiography at 3.0 T than at 1.5 T.     

烟雾病的MRI、MRA诊断价值

 目的探讨MRI、MRA对烟雾病(Moyamoya病)的诊断价值.方法对11例Moyamoya病患者行MRI和MRA检查,MRI包括横轴位和矢状位T1WI、T2WI、FLAIR;MRA采用3D TOF法,3例行增强MRA.结果MRI表现为:(1)Moyamoya血管:双侧3例,单侧8例;(2)脑梗死和脑软化灶11例;(3)局部脑萎缩3例.MRA表现为3例双侧颈内动脉狭窄,双侧大脑中、前动脉闭塞,大脑后动脉形成异常血管网;6例右侧颈内动脉、大脑中动脉狭窄;2例左侧颈内动脉、大脑中动脉狭窄.结论MRI能良好的显示脑内病变,MRA能较完整的显示异常血管,MRI与MRA相结合可作为烟雾病诊断的首选检查方法.     

小儿缺血性脑血管病的MRI及MRA诊断

目的 评价磁共振成像（MRI）及磁共振血管成像（MRA）对小儿缺血性脑血管病的诊断价值。方法 回顾性分析了42例小儿缺血性脑血管病患，年龄1.2-14岁，平均7.5岁，全部病例均以急性起病的运动，语言障碍为主要症状来诊，采用轴位T1，T2加权像，部分病例加做冠状位或矢状位成像，其中31例进行了时间飞跃（TOF）法MR血管成像。结果 本组共发现脑缺血8例，脑梗塞34例（其中腔隙梗塞22例，大面积梗塞12例），单支颅内动脉狭窄6例。多支动脉狭窄4例；单支动脉闭塞3例。多支动脉闭塞2例；MOYAMOYA病9例（其中3例可见脑底异常血管网）。4例图像上有运动伪影，但能达到诊断要求，全部病例中，MRI表现典型，能单独确诊36例，占85.7%，MRI与MRA相结合能确诊40例，达95.2%，其余2例仅用MRI及MRA不能明确诊断，需结合临床资料及经随访证实。结论 MRI结合MRA是小儿缺血性脑血管病的理想检查方法，可准确显示脑动脉的狭窄，闭塞性病变及其继发的脑缺血，梗塞病灶，对定性诊断具有重要价值。     

烟雾病MRI和MRA诊断价值(附16例报告)

目的；评价MRI和MRA对烟雾病的诊断价值。方法：分析16例烟雾病患者的MRI、MRA表现和临床资料。MRA采用三维时间飞跃法。结果：16例患者MRA检查均显示不同程度的颈内动脉分叉以上狭窄或闭塞，其中17支后交通动脉增粗，4支眼动脉增粗；16例显示基底节区异常血管网，其中6例同时显示后部异常血管网；10例显示软脑膜吻合支增多；MRI显示脑出血或脑梗塞等脑实质改变，并能显示基底节区异常血管点状流空。结论：MRI和MRA是诊断烟雾病的有效非创伤性检查方法。对该病的诊断、筛选、随访和外科5一的评价有较大价值。     

Moyamoya disease: diagnosis with three-dimensional time-of-flight MR angiography.

Twelve patients with moyamoya disease were studied with three-dimensional time-of-flight magnetic resonance (MR) angiography, and the findings were compared with results obtained with conventional arteriography. Of a total of 24 supraclinoid internal carotid arteries studied, 21 arteries (88%) were accurately evaluated with MR angiography and in three arteries the extent of occlusive disease was overestimated. Of a total of 72 large branch basal cerebral vessels, including the bilateral anterior, middle, and posterior cerebral arteries, 61 arteries (85%) were accurately evaluated with MR angiography and in 11 arteries the extent of occlusive disease was overestimated. While conventional arteriography showed basal cerebral moyamoya vessels in all 24 hemispheres, MR angiography showed moyamoya vessels in 20 of these. Of a total of 28 large leptomeningeal and transdural collateral vessels, 18 were identified with MR angiography. In the one surgical collateral vessel evaluated, MR angiography successfully showed its patency. MR angiography may have value in following disease progression and, perhaps, in evaluation of surgical bypass patency.