磁共振弥散像血管造影及颈动脉超声对短暂脑缺血发作的诊断价值

目的　评价磁共振弥散加权对比成像、数字减影血管造影术 (DSA)及颈动脉超声对短暂性脑缺血发作 (TIA)的诊断价值。方法　 10 2例颈内动脉及椎基底动脉系统TIA患者分别进行磁共振弥散加权对比成像、DSA及颈动脉超声检查。结果　 4 0例 (39.2 %)TIA患者显示脑梗死或小血管腔隙性梗死 ,其中 12例 (11.8%)患者弥散加权对比成像可显示T2 加权像不能显示的超早期梗死灶 ,有 30例患者行颈动脉多普勒超声及DSA检查 ,管腔中、重度狭窄的 10例 (33.3%)。 2 3例 (76 .7%)TIA患者DSA显示颈动脉狭窄和 (或 )相应脑动脉的狭窄及闭塞。结论　磁共振弥散加权对比成像及DSA是诊断TIA患者中超早期脑梗死和显示动脉狭窄及闭塞的敏感手段 ,颈动脉超声对管腔正常或轻度狭窄诊断的吻合率较高 ,对中、重度狭窄或闭塞诊断的准确性不如DSA。

Research on the diagnostic values of MR diffusion weighted imaging, DSA and carotid artery duplex ultrasonography in patients with transient ischemic attacks

Objective To evaluate the diagnostic values of MR diffusion weighted imaging(DWI),digital subtraction angiography (DSA) and carotid artery duplex ultrasonography in patients with transient ischemic attacks(TIA).Method 102 patients with internal carotid artery and vertebral basilar artery system TIA were examined with MR diffusion weighted imaging,DSA and carotid artery duplex ultrasonography.Results 40(39.2%) patients with TIA showed cerebral infarction or lacunar infarction and 12(11.8%) of them showed ultra acute cerebral infarction on DWI,which could not be showed by T 2WI.Thirty of them were also examined by carotid artery duplex ultrasonography and DSA.Twenty one (70.0%)patients with TIA showed atherosclerosis.Ten (33.3%) had moderate to severe stenosis.Twenty three (76.7%) patients showed carotid artery stenosis and relevant cerebral artery stenosis or occlusion on DSA.Conclusions DWI and DSA are highly sensitive in diagnosis of ultra acute cerebral infarction and arterial stenosis and occlusion.Carotid artery ultrasonography has high coincidence rate with DSA in diagnosis of normal and mild arterial stenosis,but lower accuracy rate in diagnosis of moderate to severe arterial stenosis than DSA.