颈部血管多普勒超声、数字减影血管造影、磁共振血管成像在颈动脉狭窄检查中的对比研究

目的对比分析颈部彩色多普勒超声(CDUS)、数字减影血管造影(DSA)以及磁共振血管成像(MRA)在颈动脉狭窄度评估方面的差异。方法回顾性分析81例经DSA诊断为颈动脉狭窄患者的临床资料,将其CDUS和MRA的数据与DSA结果进行比较,评价各种影像学检查在颈动脉血管狭窄及斑块检出中的敏感度、特异度和符合率。结果以狭窄率30%、50%、70%分别为节点,MRA、CDUS与DSA 3种方法检出的敏感度分别为78%、85%、73%,特异度分别为99%、98%、96%,符合率分别为90%、92%、91%,阴性预测率分别为94%、93%、90%,阳性预测率分别为95%、96%、90%,阳性似然比分别为77.8、42.5、18.25。MRA与DSA比较,敏感度分别为65%、89%、79%,特异度分别为95%、96%、98%,准确度分别为85%、92%、93%,阴性预测率分别为94%、95%、93%,阳性预测率分别为90%、93%、94%,阳性似然比分别为13.0、21.5、9.5。结论诊断颈动脉狭窄病变时,MRA特异度高,与DSA检测结果一致性较好;MRA与DSA的一致性较CDUS强。     

三维黑血磁共振成像与DSA在颈动脉狭窄诊断中的对比研究

目的 通过与DSA比较,评价三维黑血磁共振成像(3D-BB-MRI)对颈动脉粥样硬化性狭窄的临床价值.方法 同时对40例颈动脉狭窄患者行DSA和3D-BB-MRI检查,比较两者在评估颈动脉狭窄程度、病变累及范围、破溃斑块检出的差异.结果 以DSA为金标准,3D-BB MRI判断颈动脉狭窄的Spearman相关系数为0.965,以狭窄率70％为判断点,其灵敏度为93.1％、特异度为100％、准确度为95.6％和阳性预测值为100％.3D-BB-MRI显示溃疡的灵敏度为100％、特异度为93.9％、准确度为95.6％和阳性预测值为85.7％.3D-BB-MRI和DSA的病变累及范围分别为(18.4±8.2) mm和(14.0±6.2)mm,P＜0.05.结论 3D-BB-MRI能较准确地显示颈动脉狭窄程度、溃疡斑块,在显示病变累及范围方面具有优势,可辅助DSA为临床提供可靠、有价值的信息.     

颅内动脉瘤三维CT血管成像的临床研究

目的 评价和对比3D-CTA、MRA和DSA对颅内动脉瘤诊断的临床价值。方法 对96例可疑动脉瘤患者行3D-CTA,MRA和DSA检查。结果 共发现129个动脉瘤。3D-CTA发现的最小动脉瘤大小为1.6mm×1.7mm×2.0mm。3D-CTA对动脉瘤诊断的灵敏性和特异性均为100％,而MRA则分别为95.3％和97.6％,DSA为100％和97.7％;对载瘤动脉和分枝动脉的形态描述明显优于MRA和DSA(分别为P<0.05和P<0.01);在阐明动脉瘤颈的形态上明显优于MRA和DSA(P<0.01);对动脉瘤血栓化和钙化的检出率明显高于MRA和DSA(P<0.001)。3D—CTA在108例(83.7％)动脉瘤临床治疗方案的选择上提供了重要依据。结论 3D—CTA在动脉瘤检出及其特征描述上优于MRA和DSA。3D—CTA对颅内动脉瘤的临床治疗有重要的指导作用。     

颈动脉超声联合经颅多普勒超声对缺血性脑血管病的诊断价值

目的探讨颈动脉超声与经颅多普勒超声联合在缺血性脑血管疾病中的价值及意义分析。方法选取2018-01—2019-12在济源市人民医院接受缺血性脑血管疾病治疗的308例患者为研究组。并选取同时期进行体检的150名健康者作为对照组。2组均行颈动脉超声与经颅多普勒超声联合检测,并比较其检测结果。结果研究组椎动脉及基底动脉的Vm低于对照组,而PI指数则高于对照组(P0.05);经颅多普勒与颈动脉超声联合检测的敏感性为97.0%(228/235)、特异性为86.3%(63/73)、阳性预测值为95.8%(228/238),均高于单纯的经颅多普勒超声的88.1%(207/235)、71.2%(52/73)、90.8%(207/228),2组比较存在明显差异(P0.05)。结论对缺血性脑血管疾病患者采用颈动脉超声与经颅多普勒超声联合的检测方法,能够有助于对病情进行及时、有效的判定,且符合度相对较高,利于临床治疗方案的确立及有效实施。     

血管内超声在颈动脉狭窄中的应用

颈动脉狭窄是一种常见的临床疾病,在脑梗死的病因中约占60%[1]。颈动脉超声作为无创性检测手段,具有安全简便、费用低、重复性好等优点,但其空间分辨率和对比分辨率有限,不能检测颈动脉颅内段病变,不能准确鉴别血管的重度狭窄与闭塞,并存在人为误差。长期以来数字减影血管造影(     

缺血性眼病与颈动脉狭窄的相关研究

目的 探讨颈动脉狭窄的病因及缺血性眼病的发生与颈动脉狭窄的关系.方法 经颅多普勒超声(TCD)及数字减影血管造影(DSA)检查明确有颈动脉狭窄患者300例,男性246例,女性54例,年龄31～78岁,单侧126例,双侧174例.利用统计学方法对颈动脉狭窄发病的相关因素、狭窄程度及颈动脉狭窄与其所导致的缺血性眼病的关系进行分析.结果 颈动脉狭窄的主要发病因素是动脉粥样硬化;颈动脉狭窄的发病与年龄、性别、高血压、高血脂、高同型半胱氨酸血症等因素相关;颈动脉狭窄患者中37.3%出现了眼部症状,包括一过性黑矇、复视、视力下降、甚至失明,一过性黑矇是最常见的眼部症状(占37.5%),其原因与颈动脉狭窄导致视网膜中央(分支)动脉阻塞、静脉淤滞性视网膜病变、新生血管性青光眼等有关;眼部症状的出现与狭窄的程度、部位有关.结论 颈动脉狭窄造成的眼部供血下降可以导致多种缺血性眼病,眼部症状的出现与颈动脉狭窄的程度及部位有密切关系.同时也为今后的预防、治疗提供了重要的依据.     

CTA对症状性颈动脉狭窄脑梗死复发预后的评估

目的 分析多排螺旋CT血管造影（SCTA）对症状性颈动脉狭窄脑梗死复发的预后评价方法及意义。方法 回顾性分析黄河中心医院2019-01—2021-12收治的50例症状性颈动脉狭窄患者复发脑梗死病例资料,统计责任血管的狭窄率及位置分布情况,评估多排螺旋CT血管造影在症状性颈动脉狭窄患者脑梗死复发预后评价的应用效能。结果 脑梗死复发患者前循环责任血管及后循环责任血管左右两侧血管狭窄分布情况无明显差异（P>0.05）,双侧动脉均发生狭窄的情况更常见,单侧与双侧狭窄的差异有统计学意义;脑梗死复发患者责任血管多为颈总动脉和颈内动脉,单侧责任血管重度狭窄或闭塞时复发脑梗死的风险较高;复发梗死灶责任血管的影像学原始图像均显示责任血管的后端对比剂染色范围和浓度明显小于前端正常区域,提示管腔内血流量减少,责任血管支配区的脑组织局部脑供血不足,且该供血不足区域与再发梗死灶区域部分重合或完全重合。结论 症状性颈动脉狭窄患者的头颈部联合CTA检查结果应更多关注双侧动脉多发性狭窄,尤其是单侧颈总动脉和颈内动脉的重度狭窄或闭塞,此类患者复发脑梗死的风险相对较高。     

颈动脉超声和DSA对颈动脉狭窄诊断的比较

目的探讨超声检查对颈动脉狭窄的价值。方法48例脑梗死患者,行二维彩色多普勒超声检查和DSA检查观察颈动脉狭窄情况,对比两者检查结果并进行分析。结果超声对于轻度颈动脉狭窄诊断的准确性较高,与DSA吻合18/19,对于中重度狭窄诊断两者吻合为11/13。结论超声检查可以用于轻度颈动脉狭窄的诊断,但对于中重度狭窄仍需通过DSA检查来确诊及选择治疗方案。     

颈部动脉夹层磁共振成像多序列评估与信号解读

动脉夹层是指由于动脉内膜损伤使血液通过内膜进入血管壁内而导致的动脉管壁分层,当动脉夹层内的血液导致病变动脉管壁呈瘤样膨出时称为夹层动脉瘤.动脉夹层是导致青年卒中的一个常见原因,尽早明确动脉夹层的诊断是指导下一步治疗的关键[1].虽然DSA是诊断动脉夹层的"金标准"[2],但近年来HR-MRI作为无创的成像解决方案也成为...     

彩色多普勒超声诊断椎动脉夹层的价值分析

目的探讨彩色多普勒血流显像(CDFI)检测椎动脉夹层(VAD)患者的血管内径、血管内回声及血流动力学变化,评价其诊断椎动脉夹层的临床价值。方法经超声检查、数字减影血管造影(DSA)证实椎动脉夹层患者14例,研究其超声影像学特征、血流动力学参数变化。结果根据血管结构特征分为双腔型、壁内血肿型及夹层动脉瘤型,14例椎动脉夹层患者中,壁内血肿型9例(累及V1段4例,累及V2段3例,累及V1、V2段2例),双腔型5例(累及V1段3例,累及V2段1例,累及V1、V2段1例),患侧椎动脉病变部位原始管腔明显增宽,真腔内径变窄且小于原始管腔内径1/2以上时,峰值流速(PSV)和搏动指数(PI)明显高于健侧,差异有统计学意义(P0.05)。结论彩色多普勒超声可以根据患侧椎动脉二维声像图及血流动力学特征初步筛查椎动脉夹层,为临床早期诊断和治疗提供可靠信息。     

症状性急性颈内动脉不同部位闭塞侧支循环的临床研究

目的研究颈内动脉不同部位闭塞后侧支循环的特征及临床和影像表现。方法用DSA研究颈内动脉急性闭塞后侧支的形成。选择DSA确诊的颈内动脉闭塞者48例,颈内动脉颈段闭塞28例,颈内动脉脑段闭塞20例。对比两组病例侧支方式及临床和影像表现。用NIHSSS评价发病7d时神经功能状况。头部CT/MRI显示的梗死面积用(A·B·C)/2计算。结果颈内动脉颈段闭塞组前交通动脉出现率和后交通动脉出现率及眼动脉出现率,开放侧支途径≥2条,高于颈内动脉脑段闭塞组(P<0.05)。软脑膜吻合支出现率在两组间无统计学差异。颈内动脉颈段闭塞组7d时NIHSSS≤8分的患者比颈内动脉脑段闭塞组多(P<0.05),梗死面积小(P<0.05)。结论颈内动脉不同部位闭塞的侧支方式不同,脑内侧支的多少和范围决定了梗死的大小和全面的诊断。     

Internal carotid artery dissection

The purpose of this review is to increase the awareness of internal carotid artery dissection (ICAD), a potentially serious and probably underdiagnosed condition. ICAD is a not uncommon cause of stroke in young patients. ICAD may occur spontaneously or as a result of trauma. However, the "spontaneous" dissection is often preceded by a trivial trauma. The typical patient presents with ipsilateral headache or neck pain, ipsilateral Horner's syndrome and delayed ischemic symptoms from the ipsilateral hemisphere or retina. Conventional angiography, the gold standard for diagnosis, tends to be replaced by non-invasive diagnostic methods. There are no evidence-based guidelines for therapy although anticoagulation is most commonly used. The references are selected from the Medline database for the years 1966-1997.     

Vessel wall MRI for suspected isolated basilar artery dissection

Isolated basilar artery dissection is an uncommon intracranial vasculopathy with a poor prognosis. Digital subtraction angiography is considered the definitive modality for diagnosis. Vessel wall MRI (VW-MRI) is an emerging non-invasive technique for assessing the structural integrity of intracranial vessel walls and lumina. Recently, a small number of studies have described the vessel wall patterns of intracranial artery dissection. However, studies on vessel wall imaging of isolated basilar artery dissection remain limited. We describe a patient with suspected isolated spontaneous basilar artery dissection diagnosed using VW-MRI.     

Intracavernous carotid artery aneurysms

Six patients with intracavernous carotid artery aneurysms (ICCAAns) were seen at our department from 1998 to 2002. All patients had only one intracranial aneurysm and their ages at diagnosis ranged from 36 to 72 years (median 56). Five were women and four had a history of hypertension. One patient was pregnant. All of the ICCAAns were symptomatic at diagnosis. Duration of symptoms was 2–30 days. On admission to our department, initial symptom was headache in four patients, visual loss in two, eye pain in one, third nerve paresis in two and subarachnoid hemorrhage (SAH) in one. Spontaneous thrombosis was present in two patients. All of the ICCAAns were saccular. Computed tomography (CT) was superior when compared with magnetic resonance imaging (MRI) for diagnosis of ICCAAns on admission. Angiography remains the gold standard for diagnosis and determination of specific anatomical details, which are necessary to plan treatment.     

MRI in internal carotid artery dissection

We report two cases of internal carotid artery dissection in which MRI unequivocally demonstrated the intramural hematoma. We propose that, whenever the clinical presentation or the angiogram suggest arterial dissection, MRI be done to confirm the diagnosis.

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Sommario Gli autori descrivono due casi di dissecazione della arteria carotide interna, in cui la Risonanza Magnetica dimostrò inequivocabilmente l'ematoma intramurale. Propongono che la Risonanza Magnetica sia eseguita ogni qualvolta la clinica o l'angiografia suggeriscano una dissecazione arteriosa.

     

Spontaneous dissection of the cervical internal carotid artery

Five patients with spontaneous dissection of the cervical internal carotid artery (CICA) are reported. The different patterns of clinical and radiological presentation are described and the frequently benign outcome is underlined. The need for diagnostic angiography is emphasized.     

Magnetic resonance angiography of spontaneous vertebral artery dissection suspected on Doppler ultrasonography

Spontaneous vertebral artery dissection (VAD) is a rare but well-known cause of cerebrovascular disease and is often difficult to diagnose even using conventional arteriography. While noninvasive tests such as Doppler ultrasonography and magnetic resonance imaging (MRI) have failed to provide reliable criteria for the diagnosis of VAD, the diagnostic value of magnetic resonance angiography (MRA) has not yet been undetermined. To establish the reliability of a combined noninvasive approach, 11 patients were prospectively examined for VAD by means of colour-coded duplex studies, MRI and three-dimensional time-of-flight MRA prior to conventional angiography. Among 11 patients with VAD suspected clinically as well as on Doppler ultrasonography, angiography confirmed the diagnosis in seven patients but found a vertebral artery occlusion in three and a vertebral artery stenosis in one. The combination of MRI and MRA findings led to the correct diagnosis of dissection in three patients, of vertebral artery occlusion in three patients, and of vertebral artery stenosis in one. VAD was misinterpreted as vertebral artery occlusion in four patients. Doppler ultrasonography is a valuable screening method for the detection of vertebral artery pathologies. The diagnosis of VAD can only be established if a typical intramural vessel wall haematoma is seen on T1-weighted MRI in combination with MRA findings of irregular artery stenosis or occlusion.