进展性卒中与脑动脉狭窄的脑血管造影研究

目的探讨进展性脑梗死的影像学特点及与脑动脉狭窄之间的相关性。方法选择我院29例进展性脑梗死患者并与同期收治的31例完全性脑梗死患者比较,所有患者均行头颅MRI (或头颅CT)及脑血管造影检查(DSA检查),分析进展性脑梗死的影像特点及其与脑动脉狭窄的相关性。结果进展性脑梗死组分水岭脑硬死或侧脑室体旁梗死发生率72．4％(21／29)及脑动脉狭窄发生率75．86%(22／29)均明显高于完全性脑梗死组22．6％(7／31),35．48％(11／31)。进展性脑梗死组中重度狭窄发生率为55．17％(16／29),高于完全性脑硬死组的12．90%(4／31)。溃疡性斑块发生率在进展性脑梗死组48．28%(14／29)高于完全性脑梗死组16．13％(5／31)。结论中重度脑动脉狭窄及溃疡是进展性卒中的重要危险因素,应早期检查及处理脑动态狭窄以防止病情进展。     

复发性后循环脑梗死患者血管病变特点

目的探讨复发性后循环脑梗死患者脑血管病变的特点。方法对62例复发性后循环脑梗死患者进行DSA检查,分析血管病变的部位、性质和程度。结果本组58例(93.5%)患者有血管狭窄,其中重度狭窄41例(66.1%),轻中度狭窄17例(27.4%);血管动脉硬化的患者4例(6.4%)。单纯前循环血管病变3例(4.8%),单纯后循环血管病变18例(29.0%),前后循环血管均病变41例(66.1%)。椎动脉病变53例(85.5%),颈内动脉38例(61.3%),基底动脉14例(22.9%),大脑中动脉6例(9.7%),颈总动脉3例(4.8%)。结论复发性后循环脑梗死患者的主要血管病变部位在椎动脉和颈内动脉,血管病变的主要病理特征为动脉粥样硬化及在此基础上形成的血管狭窄,且以重度狭窄最为多见。     

连续40例出血型烟雾病的DSA影像学分析

目的探讨烟雾病患者的DSA影像学诊断特征。方法回顾性分析40例烟雾病病例的DSA影像学表现,40例患者均经CT诊断为颅内出血,均经DSA确诊。结果双颈内动脉末段狭窄闭塞22例,一侧颈内动脉末段狭窄闭塞8例,一侧大脑中动脉狭窄闭塞3例,双侧大脑前动脉和一侧大脑中动脉狭窄闭塞1例,双侧大脑前动脉狭窄闭塞3例,双侧大脑中动脉狭窄闭塞1例,一侧大脑中动脉及对侧大脑前动脉狭窄闭塞2例,均伴颅底异常血管网形成。结论DSA为诊断烟雾病的金标准,DSA检查可清楚显示烟雾病血管狭窄闭塞的部位、侧支循环情况及是否合并动脉瘤,据其表现可指导进一步治疗。     

NF-κB、ICAM-1在实验性SAH后基底动脉壁上的表达变化

目的 探讨免疫炎症反应在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)发病机制中的作用.方法 应用新西兰家兔经枕大池二次注血制成SAH动物模型.在各相应时间点运用数字减影血管造影(digital subtraction angiography,DSA)、HE染色和免疫组化等方法 ,观察兔基底动脉管壁形态以及核转录因子kappaB(nuclear factor-kappaB,NF-κB)、细胞间粘附因子-1(intercellular adhesion molecule,ICAM-1)在管壁上表达的动态变化.结果 在SAH后第3天基底动脉血管腔已开始狭窄,第7天达到高峰,之后狭窄渐减轻,14d时基本接近正常.SAH后3d NF-κB表达增加,5～7d表达持续在一个较高的水平,随后开始下降;ICAM-1表达变化趋势与NF-κB相似,但在表达高峰时相上稍迟于后者.结论 NF-κB、ICAM-1在血管壁上的表达变化与CVS的发生时相密切相关,提示由其参与介导的血管壁炎症反应可能在CVS的发生和发展过程中起了重要的作用.

Abstract：

Objective To evaluate the possible effect of inflammatory reaction in the pathogenesis of CVS after SAH.Methods The "double-hemorrhage" model of vasospasm Was performed by two injections of autologous aterial blood into the cisterna magna of Newzealand rabbits.We oberserved morphological changes and the rule of expression and activity of NF-κB and ICAM-1 in basilar artery(BA)walls by DSA,light microscope and immunohistochemistry.Results The "double-hemorrhage"model of vasospasm was succeeded to be made.The BA vasospasm Was obvious on 3d after autologous aterial blood wa8 first injected into the cisterna magna,and peaked on 7d,and then relieved.On 14d,there was almost no abnormality in the arterial wall.Upregulation of NF-κB expression started on 3d,became stronger on 5d to 7d,and then decreased.The upregulation of ICAM-1 expression in the BA walls Was similar with NF-κB,but was a bit later to tively correlated with the vasospasm.Inflammatory reaction in arterial walls mediated by NF-8κB may play a key mle in the process of CVS after SAH.     

老年人蛛网膜下腔出血的临床特点与DSA研究

目的 探讨老年人蛛网膜下腔出血(SAH)的临床特征与DSA之间的关系,以提高诊治水平.方法 回顾分析1995年9月～2004年3月北京医院神经外科收治的60岁以上的SAH 152例的临床资料与DSA结果对比分析.结果 老年人SAH仍以动脉瘤破裂出血为主,152例中行DSA133例(87.5%),动脉瘤患者119例(89.5%),发现动脉瘤129个,其中多发性动脉瘤7例,动脉瘤多分布在前、后交通动脉(61.2%),DSA阴性者10例(7.5%),动静脉畸形(AVM)3例,moyamoya病1例.头痛、脑膜刺激征发生率低,程度也较轻,意识障碍及并发症多见.结论 了解和重视老年人SAH的临床特征,尽早行DSA检查,对颅内动脉瘤及时行血管内栓塞治疗,可避免再出血,减少并发症,降低死亡率.     

MRI、320-CTA及DSA在脊髓血管病诊断中的应用

目的 通过对比分析脊髓血管病在MRI、320-CTA及DSA中的特点,探讨三者在脊髓血管病诊断中的作用。方法 回顾性分析34例脊髓血管病患者影像学资料,34例均行DSA检查,33例行MRI检查,14例行320-CTA检查;同时行MRI及DSA检查31例,同时行320-CTA及DSA检查13例,同时行MRI、320-CTA及DSA检查13例。结果 DSA检查确诊为硬脊膜动静脉瘘20例,髓内动静脉畸形7例,髓周动静脉瘘3例,双侧甲状颈干发育异常1例,3例阴性。30例MRI检查考虑脊髓血管病,28例经DSA检查得到证实,2例DSA检查为阴性;1例MRI诊断为颈6~7椎体水平脊髓血管畸形,DSA检查诊断双侧甲状颈干发育异常;MRI诊断符合率为90.3%（28/31）。10例320-CTA检查诊断为脊髓血管病,其中8例诊断为硬脊膜动静脉瘘,2例为髓内动静脉畸形;7例硬脊膜动静脉瘘及1例髓内动静脉畸形的320-CTA诊断与DSA诊断结果一致;3例320-CTA阴性结果与DSA一致;1例320-CTA考虑后颅窝延髓前及颈1~6水平硬脊膜动静脉瘘,但DSA检查为阴性;1例320-CTA考虑髓内动静脉畸形,DSA诊断为动静脉瘘;320-CTA诊断符合率为84.6%（11/13）。结论 MRI适用于脊髓血管畸形的初步筛查;320-CTA可以无创、快速、全面地显示脊髓血管病,为DSA检查进一步提供目标,缩短DSA诊疗时间,降低漏诊率,同时可以明确病灶在椎管内的具体位置,指导手术;DSA是诊断脊髓血管病的金标准,是进一步治疗的基础。     

颅内动脉瘤DSA诊断与显微手术治疗

目的分析报告30例颅内动脉瘤的DSA诊断与手术治疗特点,提高诊治水平.方法对自发性蛛网膜下腔出血(SAH)的病例均予以全脑血管DSA造影并对载瘤血管加照"手术位"造影片,诊断明确后显微手术治疗.结果发现动脉瘤30例,28例成功夹闭瘤颈,脑血管造影满意,2例行动脉瘤包裹.结论全脑血管DSA造影、"手术位"造影的应用及显微手术治疗是治疗颅内动脉瘤的有效手段.     

脑血管病血管造影的诊断及介入治疗的临床应用

目的探讨DSA在脑血管病因诊断中及血管内介入治疗中的应用价值。方法回顾性分析430例不同脑血管病的DSA阳性检出率、安全性及临床特点,对颈动脉狭窄,部分脑动脉瘤,脑血管畸形进行血管内介入栓塞的疗效评价。结果所有受检者无1例发生永久性神经功能缺损。总的DSA阳性检出率高（66．74％）,其中缺血性脑血管病阳性率最高（82．85％）,主要血管病变为脑动脉粥样硬化性狭窄或闭塞,颅外段受累多见。其次为蛛网膜下隙出血（65．04％）、脑实质出血（52．77％）、单侧动眼神经麻痹（66．66％）、头痛待诊（43．47％）阳性率也高,但总患者数尚少。症状性癫痫的DSA结果均为阴性。结论规范化操作可充分保障DSA检查的安全性。慎重筛查DSA纳入患者可提高DSA的阳性检出率及提高效率／费用比,有效指导二级预防治疗,血管内介入治疗具有疗效好,安全性高,创伤小等优点。     

16层CTA与DSA诊断颅内动脉瘤效能的对比研究

目的 对比CTA与DSA诊断颅内动脉瘤的效能.方法 首都医科大学附属北京天坛医院神经外科自2007年7月至2008年7月连续收治疑动脉瘤患者82例,均行DSA与CTA检查,确诊为动脉瘤患者行手术治疗.比较DSA、CTA检查的阳性率和二者诊断动脉瘤的特异性、敏感性和准确性.比较CTA检查与术中测量瘤体、瘤颈直径的大小,观察CTA、DSA检查对不同部位、大小动脉瘤的显示情况.结果 CTA检出动脉瘤74个,DSA正确检出81个,二者阳性率差异无统计学意义(x2=1.897,P=0.163).以DSA检查结果为标准,CTA发现动脉瘤的灵敏性为91.4%(74/81),特异性为91.7%(11/12),准确性为91.4%(85/93);65例患者行手术治疗,术中发现动脉瘤73个,以手术结果为标准,CTA、DSA检查的灵敏性比较差异有统计学意义(P<0.05),特异性、准确性比较差异无统计学意义(P>0.05);与术中测量的瘤体、瘤颈直径比较,CTA检查结果较大,差异有统计学意义(P<0.05);CTA检查对不同部位、大小动脉瘤的灵敏度不同,而DSA检查具有较高敏感性.结论 16层CTA具有无创、快捷、敏感、高效等优点,可做为筛选动脉瘤的方法,部分患者可凭CTA指导手术.

Abstract：

Objective To assess the values of 16-slice CTA and DSA in the diagnosis of intracranial aneurysms. Methods Eighty-two patients with SAH,suspected having aneurysms and admitted to our hospital from July 2007 to July 2008,received DSA and CTA;the clinical data of these patients were analyzed;CTA images were compared blindly with the DSA findings,including the presence,location,and size of aneurysms.With SPSS 11.5 statistical software,the sensitivity,specificity and accuracy of CTA and DSA were compared. Results Eighty-one aneurysms were detected by DSA and 74 aneurysms by CTA;no significant difirences on the positive detected rate were noted(x2=1.897,P=0.163).The sensitivity of CTA for detection of all aneurysms versus that of DSA was 91.4%,the specificity of CTA 91.7%.and the accuracy of CTA 91.4%.Sixty-five patients underwent surgery (clipping)and 73 aneurysms were confirmed by this surgery;CTA had a sensitivity of 89.0%,specificity of 100%and accuracy of 90.5%:DSA had a sensitivity of 98.6%,specificity of 84.6%and accuracy of 98.8%;significant statistical diference on sensitivity (x2=5.625,P<0.05)and no significant statistical diference on specificity and accuracy (x2=1.846 and 2.450,respetively,P>0.05)were found between them.As compared with the sizes of aneurysms and the diameters of aneurysm necks measured during the operation,these results detected by CTA were significantly larger(P<0.05).CTA had different detection sensitivities to aneurysms at different locations and with different sizes,while DSA had high sensitivity.Conclusion CTA is a noninvasive, quick, sensitive and efficient tool to diagnose inrtacranial aneurysms.It can be specially used to screen aneurysms in SAH patients.In some cases,CTA can guide the surgery.