MRA与DSA在椎动脉型颈椎病诊断中的应用比较

目的对比椎动脉磁共振造影(magneticresonanceangiography,MRA)与数字减影血管造影(digitalsubtractionangiography,DSA)诊断椎动脉型颈椎病的意义。方法自2001年11月至2004年2月,共收集临床诊断为椎动脉型颈椎病的患者35例,男11例,女24例;年龄23～76岁,平均58.3岁。同时行MRA及DSA检查,观察椎动脉的走行、管径、是否存在狭窄及狭窄部位等。结果DSA检查有阳性发现者32例,其中单侧椎动脉受累19例,双侧受累13例。MRA有阳性发现者29例,其中单侧椎动脉受累14例,双侧受累15例。除5例MRA阳性而DSA阴性外,其他MRA与DSA均为阳性。两种方法对管腔变细的诊断吻合率为100%。DSA对局限性狭窄及单侧缺如的诊断优于MRA。MRA对颈椎不稳及增生导致的椎动脉迂曲变形等表现的诊断阳性率高于DSA。结论(1)椎动脉DSA检查对局限性压迫及动力性压迫的诊断较准确,对椎动脉压迫来源较易作出判断,检查中可变换体位。缺点是为有创检查,存在造影剂副反应及用量的限制。(2)MRA为无创检查,容易诊断弥漫性、长节段狭窄及闭塞,对合并其他类型颈椎病患者较适用。可同时扫描颈椎间盘、脊髓及颈部其他血管,以进行鉴别诊断。适用于临床诊断不明确、高龄不能耐受DSA检查的患者。MRA的不足之处是对局部微小部位的狭窄或非闭塞性病变的诊断率低,检查中无法随时变换体位。

Value of MRA and DSA in diagnosing vertebral arterial insufficiency of cervical spondylosis

Objective To realize the value of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) in diagnosing vertebral arterial insufficiency of cervical spondylosis. Methods From Nov. 2001 to Feb. 2004, 35 vertebral arterial insufficiency of cervical spondylosis was diagnosed clinically. There were 11 males and 24 females with a mean age of 58.3 years(range, 23 to 76 years). All the patients were examined by MRA and DSA to investigate the tracks, diameters, and stenosis locations of vertebral articles. Results DSA was positive in 32 patients with 19 ipsilateral and 13 bilateral. Meanwhile, MRA positive were in 29 patients, 14 ipsilateral and 15 bilateral. Among MRA positive patients, excepted 5 cases, all the others were also positive with DSA. Accordance of both methods in the diagnosis of thin veterbral artery was 100%. DSA was better than MRA in the diagnosis of localized stenosis and unilateral veterbral artery absence. MRA was much more useful than DSA in the diagnosis of veterbral artery twisting caused by vertebral instability and bone spurs. Conclusion 1) DSA had more accuracy in diagnosis and distinguishing the source of veterbral artery localized stenosis. Posture changing didn't disturb the examination. Its disadvantages, however, were invasive detection, side-effect and dose limitation of contrast medium. 2) As a non-invasive method, MRA was a useful tool in diagnosing diffused, long segmental artery stenosis and obstruction, and especially available for diagnosing the cervical spondylosis combinated with other type. MRA can scan vertebral disc, spinal cord and other vessels at the same time. The indication of MRA was indefinite diagnosis, aged patients with bad tolerance to DSA. The disadvantage of MRA was its low sensitivity in detecting mild stenosis, non-obstruction artery disease, and posture demand during examination.