多普勒超声和增强磁共振血管造影对颈动脉、椎动脉和基底动脉在后循环缺血性病因中的诊断价值

目的：探讨经颅多普勒超声（TCD）、颈动脉和椎动脉彩色多普勒超声（CDU）、颅颈部增强磁共振血管造影（CE-MRA）检测对后循环缺血（PCI）病因诊断的价值。方法：对临床已确诊为PCI的60例患者行TCD和颈动脉、椎动脉CDU检测，其中47例另行颅颈部CE-MRA检查。结果：①在TCD检测的60例患者中显示后循环血流异常45例（75％）。②颈动脉和椎动脉CDU检测，发现椎动脉异常38例（63．33％），其中椎动脉狭窄变细20例、椎动脉走行迂曲8例、仅有椎动脉壁硬化而无狭窄6例及椎动脉硬化伴有斑块形成10例。⑧47例患者颅颈部CE-MRA检查：后循环异常33例，阳性率为70．21％。其中椎动脉异常27／47例（57．45％）、椎动脉起始狭窄15／47例（31．91％）、椎动脉起始变异3／47例（6．38％）、椎动脉迂曲6／47例（12．77％）、椎动脉V2段局部狭窄2例、椎动脉V4段轻度狭窄2例。结论：TCD可以对椎动脉血流动力学的变化进行量化分析，可作为PCI的早期筛查手段。颈动脉和椎动脉CDU检测在显示颅外段椎动脉内径，椎动脉壁动脉硬化、斑块形成和钙化等动脉壁结构的变化上占优势，而整体形态学影像则不如CE—MRA。颅颈部CE-MRA可显示椎动脉狭窄，在椎动脉整体形态的显像上占优势，可为PCI的病因诊断提供依据。

Diagnostic Value of Doppler Ultrasound and Contrast-enhanced MRA of the Carotid and Vertebral Artery,Basflar Artery in the Examination of Posterior Circulation Ischemia

Aim： To study the value of transcranial Doppler （TCD）, colour Doppler ultrasound（CDU）, and con~ast enhanced-magnetic resonance angiography （CE-MRA） in clinical diagnosis of the posterior circulation ischemia （PCI）. Methods： TCD and CDU were performed in 60 patients with PCI, and 47 of these were examined by CE- MRA. Results： （1）TCD examination to 60 patients showed that there were 45 patients （positive rate was 75%） with abnormal velocity of blood flow of vertebrobasilar arteries. （2） CDU examination to 60 patients showed that there were 38 patients （positive rate was 63.33%） with abnormal vertebral artery, 20 patients of these with stenosis, 8 patients with distortion, 6 patients with sclerosis and no stenosis, 10 patients with sclerosis and plaque. （3）CE-MRA examination to 47 patients showed that there were 33 patients （positive rate was 70.2%） with abnormal vertebrobasilarartery system, 27 patients of these with abnormal vertebral artery, 15 patients with stenosis of the first segment of vertebral artery, 3 patients with variation of the first segment, 6 patients with distortion, 2 patients with stenosis of segment V2, 2 patients with stenosis of segment V4. Conclusion： TCD might be a screening method in the early diagnosis of PCI by studying the hemodynamics of vertebral artery. CDU showed the variation of structure of extracranial vertebral artery with internal diameter, sclerosis, plaque and calcification. And it was more inferior to MRA in entirety morphology. CE-MRA could provide basis for etiological diagnosis of PCI.