缺血性脑血管病颈动脉狭窄15例影像诊断

目的　评价颈动脉狭窄无创性影像学检查方法的临床应用价值 ,探讨颈动脉狭窄与缺血性脑血管病之间的联系。材料与方法　对 15例 3 0支颈动脉行多普勒超声 (DUS)、磁共振血管造影 (MRA)及头部CT、MRI检查。其中 5例同时行颈动脉CT血管造影 (CTA) ,4例与DSA对照 ,6例颈动脉重度狭窄者行颈动脉内膜切除术。结果　 15例 3 0支颈动脉 ,轻度狭窄 ( <3 0 % ) 8支 ,中度狭窄 ( 3 0 %～ 69% ) 6支 ,重度狭窄 ( 70 %～ 99% ) 8支 (均为一侧 ) ,闭塞 2支 ,未见狭窄 6支。 8支颈动脉重度狭窄者狭窄侧腔隙性脑梗死 5例 ,狭窄对侧皮层梗死 1例 ,双侧脑梗死 1例 ,未见异常 1例。颈动脉闭塞侧大脑中动脉分布区脑梗死 2例。CTA显示硬化斑块 3例。结论　颈动脉狭窄与脑梗死的发生、发展密切相关。DUS、MRA、CTA结合使用能够在颈动脉狭窄的筛选、诊断、监测中发挥重要作用。     

TCD与MRA对缺血性脑血管病脑动脉狭窄检出率的对比分析

缺血性脑血管病是神经内科常见病,经颅多普勒超声（transcranial Doppler ultrasound．TCD）和磁共振血管成像（magnetic resonance angiograghy,MRA）检查技术对缺血性脑血管病具有很高的临床诊断价值。     

小儿缺血性脑血管病的MRI及MRA诊断

目的 评价磁共振成像（MRI）及磁共振血管成像（MRA）对小儿缺血性脑血管病的诊断价值。方法 回顾性分析了42例小儿缺血性脑血管病患，年龄1.2-14岁，平均7.5岁，全部病例均以急性起病的运动，语言障碍为主要症状来诊，采用轴位T1，T2加权像，部分病例加做冠状位或矢状位成像，其中31例进行了时间飞跃（TOF）法MR血管成像。结果 本组共发现脑缺血8例，脑梗塞34例（其中腔隙梗塞22例，大面积梗塞12例），单支颅内动脉狭窄6例。多支动脉狭窄4例；单支动脉闭塞3例。多支动脉闭塞2例；MOYAMOYA病9例（其中3例可见脑底异常血管网）。4例图像上有运动伪影，但能达到诊断要求，全部病例中，MRI表现典型，能单独确诊36例，占85.7%，MRI与MRA相结合能确诊40例，达95.2%，其余2例仅用MRI及MRA不能明确诊断，需结合临床资料及经随访证实。结论 MRI结合MRA是小儿缺血性脑血管病的理想检查方法，可准确显示脑动脉的狭窄，闭塞性病变及其继发的脑缺血，梗塞病灶，对定性诊断具有重要价值。     

MRI T1 W-SPACE对缺血性脑血管病的诊断价值

目的：探讨反转角快速自旋回波的三维脑动脉血管壁成像(T1 W-SPACE)技术对缺血性脑血管疾病诊断的可行性,并与磁共振定位扫描血管成像(TOF-MRA)比较,以全面认识和评估该方法。方法收集患有脑卒中但病情稳定的50例患者,包括既往有短暂性脑缺血(TIA)或有脑卒中病史,先行 TOF-MRA 及常规 MRI 序列检查,然后进行 T1 W-SPACE 检查。结果50例患者中,MRI 常规序列阳性43例,TOF-MRA 发现血管狭窄病变76支,T1 W-SPACE 发现血管狭窄病变73支,两者差异无统计学意义(χ2=0.625,P >0.05);常规 TOF-MRA 无法观察血管壁,T1 W-SPACE 发现动脉血管壁增厚、斑块的病变血管数48支。结论与TOF-MRA 比较,T1 WI-SPACE 不仅可以观察血管腔是否存在狭窄,还可以观察血管壁及斑块,并可以从病理角度对斑块进行分型,对脑中风的早期预防和治疗有重要临床意义。     

下肢动脉慢性闭塞症的MRA诊断

目的：对ＭＲＡ在下肢动脉慢性闭塞症中的诊断价值作一初步评估。材料与方法：５４例下肢动脉慢性闭塞症患者，行二维时间飞跃法ＭＲＡ检查，范围包括主动脉下段、髂动脉、股动脉、动脉及其三分支。其中２１例同时行动脉造影，１８例手术探查。结果：２１例ＭＲＡ与动脉造影对照，可比动脉节段１６８个，其中正常或轻度狭窄４６个节段，中度狭窄２７段，重度狭窄４６段，闭塞４９段，两者符合率为９２．２６％（１５５／１６８）。１８例与手术对照，可比动脉节段８２个，符合率为９２．６８％（７６／８２）。同时进行的２３例双功能多普勒超声测定踝／肱指数显示，踝／肱指数＜０．５，ＭＲＡ显示血管为重度狭窄或闭塞。结论：下肢动脉ＭＲＡ与手术、动脉造影、踝／肱指数比较，具有很好的一致性，能比较准确地评价下肢动脉慢性闭塞性病变，尤其对重度狭窄和闭塞准确性较高。     

脑动静脉畸形的MRI及MRA诊断价值

目的：研究脑动静脉畸形（ＡＶＭ）的ＭＲＩ特征,探讨其诊断价值。方法：使用ＧＥｓｉｇｎａ ｅｃｈｏ ｓｐｅｅｄ１．５Ｔ超导ＭＲ机对７１例ＡＶＭ患者分别行ＭＲＩ及ＭＲＡ检查。ＭＲＩ采用ＳＥＴ１和ＦＳＥＴ２加权序列,ＭＲＡ采用３Ｄ－ＴＯＦ序列。结果：ＭＲＩ及ＭＲＡ能显示ＡＶＭ的瘤巢,ＡＶＭ的继发改变ＭＲＩ能很好显示,ＭＲＡ能显示ＡＶＭ的三维解剖结果。结论：ＭＲＡ和ＭＲＩ是无创性评从脑ＡＶＭ的有效方法,两     

MR灌注加权成像在缺血性脑血管病中的应用价值

MR灌注加权成像可以反映组织的微血管结构和血流灌注情况,提供血流动力学方面多参数的信息,对早期诊断和治疗缺血性脑血管病有重要意义.就其原理及在缺血性脑血管病中的应用进行综述.     

MR灌注加权成像在缺血性脑血管病中的应用价值

MR灌注加权成像可以反映组织的微血管结构和血流灌注情况,提供血流动力学方面多参数的信息,对早期诊断和治疗缺血性脑血管病有重要意义。就其原理及在缺血性脑血管病中的应用进行综述。     

高分辨磁共振血管造影检查颈动脉粥样斑块与缺血性脑血管病相关性分析

目的　观察缺血性脑血管病患者颈动脉粥样硬化发生情况,探讨缺血性脑血管病与颈动脉粥样硬化的关系。方法　采 用磁共振血管成像,对126例经CT、MRI证实的缺血性脑血管病患者和126例非缺血性脑血管病患者的颈动脉硬化情况进行观察, 同时对数据进行统计学分析。结果　在126例缺血性脑血管病患者中,82例有不同程度的颈动脉斑块形成,发生率为68.3%;而非缺 血性脑血管病组126例中仅38例,发生率为35.7%,两组间差异有统计学意义(P<0.01)。结论　磁共振血管造影检查能早期发现 颈动脉粥样硬化,颈动脉硬化斑块与缺血性脑血管病密切相关。     

急性缺血性脑血管病全脑血管造影围手术期常见并发症及原因分析

目的：分析急性缺血性脑血管病全脑血管造影围手术期并发症原因和处理对策,探讨预防措施。方法：选择我科153例经数字减影全脑血管造影检查的急性缺血性脑血管病患者,统计分析并发症数量、种类、严重性、可能的原因和处理措施。结果：①所选病例未发生严重并发症;②非严重并发症发生总数为21例,部分患者2种以上,主要有与穿刺相关的并发症、系统并发症、器材操作相关并发症、对比剂相关并发症、神经系统相关并发症5类。结论：急性缺血性脑血管病进行DSCA检查可发生一些非严重并发症,及时发现处理并发症、熟练介入操作技巧可有效减轻、减少并发症。     

造影增强MR血管成像对急性缺血性中风患者血管状况的评估价值

目的:探讨CE-MRA在急性缺血性中风患者血管状况评估中的可行性。方法:27例大脑中动脉供血区急性缺血性中风患者在发病后6h内进行了TOF-MRA和CE-MRA检查,根据随访结果,对TOF-MRA和CE-MRA在急性缺血性中风患者血管状况的评估价值进行了对比分析。结果:①在27例患者中,有11例患者在TOF-MRA上表现为大脑中动脉完全闭塞而在CE-MRA上仍可见残余血流,随访结果与CE-MRA结果一致;②CE-MRA的扫描时间明显短于TOF-MRA;③CE-MRA可以在不增加扫描时间的情况下对颈部动脉和颅内动脉同时成像。结论:CE-MRA能够及时、准确地对急性缺血性中风患者血管状况进行评估,优于常规的TOF-MRA,由于急性缺血性中风患者需要紧急处理,在应用MR评估血管状况时CE-MRA应为首选。     

缺血性脑血管病颈动脉狭窄的影像诊断

目的　评价颈动脉狭窄无创性影像学检查方法的临床应用价值,探讨颈动脉狭窄与缺血性脑血管病之间的联系。　材料与方法　对15例30支颈动脉行多普勒超声（DUS）、磁共振血管造影（MRA）及头部CT&MRI检查。其中5例同时行颈动脉CT血管造影（CTA）,4例与DSA对照,6例颈动脉重度狭窄者行颈动脉内膜切除术。　结果　15例30支颈动脉轻度狭窄（<30%）8支,中度狭窄(30%～69%)6支,重度狭窄(70%～99%)8支(均为一侧),闭塞2支,未见狭窄6支。8支颈动脉重度狭窄者狭窄侧腔隙性脑梗死5例,狭窄对侧皮层梗死1例,双侧脑梗死1例,未见异常1例。颈动脉闭塞侧大脑中动脉分布区脑梗死2例。CTA显示硬化斑块3例。　结论　颈动脉狭窄与脑梗死的发生、发展密切相关。DUS、MRA、CTA结合使用能够在颈动脉狭窄的筛选、诊断、监测中发挥重要作用。     

MRA in patients with cerebrovascular disease. Considerations of clinical effectiveness

Objective:
To establish in which clinical contexts cerebral MR angiography (MRA) is routinely carried out in a neurological university department and to describe its clinical impact.
Material and Methods:
Medical records, reports of findings and documentation of imaging examinations carried out in all 69 patients referred to the Department of Radiology from the Department of Neurology between 1995 and 1998 for cerebral MRA were evaluated. The clinical impact of all imaging findings was assessed on the basis of the medical records.
Results:
Circulatory disturbances in the vertebrobasilar arteries (n=34) were the most frequent indication for investigation. MRA followed CT or duplex sonography in 66 of the 69 patients with a mean delay of 8 days. MRA was considered diagnostically inferior to conventional MR in 11 cases, comparable in 30 and superior in 25. Comparing MRA and duplex sonography, the corresponding figures were 12, 29 and 23. In retrospect, 56 MRAs were judged unnecessary.
Conclusion:
Controlled clinical studies on optimal use of MRA are needed to avoid wasting resources and to exploit the method's full diagnostic potential in appropriate cases.     

脑血管病变115例CT血管成像分析

目的：探讨64层螺旋CT脑血管成像（MSCTA）对脑血管病变的诊断价值。方法：经64层螺旋CT脑血管成像检查的病例,使用减影方法进行后处理,得到VR、MIP图像,原始图像重建得到MPR、CPR图像,综合四种图像诊断脑血管病变,并与DSA诊断进行对照分析。结果：115例脑血管病变中,动脉瘤62例（53.91%）、动静脉畸形（AVM）6例（5.21%）、脑静脉畸形（CVM）3例（2.61%）,脑动脉狭窄或闭塞38例（33.04%）、烟雾病3例（2.61%）、海绵窦动静脉瘘2例（1.74%）、海绵状血管瘤1例（0.87%）。其中46例DSA检查结果均与MSCTA一致。结论：64层螺旋CT脑血管成像是一种安全、快速、无创的检查方法,可作为颅内血管性病变筛查和术前评估的首选检查技术。     

缺血性脑血管病患者多层螺旋CT血管造影情况分析

目的根据螺旋CT血管造影（CTA）情况,探讨缺血性脑血管病患者颅内外血管粥样硬化斑块的性质、成分和动脉管腔狭窄程度与缺血性脑血管病的关系。方法选择缺血性脑血管病患者45例,经头颈部螺旋CT血管造影（CTA）,分析脑动脉管腔狭窄程度及动脉粥样斑块的性质、成分。结果45例患者中,CTA检出各种斑块（钙化斑、软斑、混合斑）33例（73．3％）,22例（48．8％）有动脉狭窄,血管闭塞5例。颅外动脉狭窄最常见的部位是颈内动脉起始部,颅内动脉狭窄最常见的部位是大脑中动脉M1段。结论缺血性脑血管病患者的颅内外动脉斑块发生率均较高,动脉粥样硬化致血管狭窄前循环发生率高于后循环,Ⅲ、Ⅳ级狭窄动脉相应供血区域大多出现缺血病灶,头颈动脉多层CTA可以准确评价颅内外动脉的病变情况,对脑卒中的二级预防具有重要指导意义。     

Two-dimensional thick-slice MR digital subtraction angiography for assessment of cerebrovascular occlusive diseases

Although spatial resolution of current MR angiography is excellent, temporal resolution has remained unsatisfactory. We evaluated clinical applicability of 2D thick-slice, contrast-enhanced subtraction MR angiography (2D-MR digital subtraction angiography) with sub-second temporal resolution in cerebrovascular occlusive diseases. Twenty-five patients with cerebrovascular occlusive diseases (8 moyamoya diseases, 10 proximal internal carotid occlusions, and 2 sinus thromboses ) were studied with a 1.5-T MR unit. The MR digital subtraction angiography (MRDSA) was performed per 0.97 s continuously just after a bolus injection of 15 ml of gadolinium chelates up to 40 s in sagittal (covering hemisphere) or coronal planes. Subtraction images were generated at a workstation. We evaluated imaging quality and hemodynamic information of MRDSA in comparison with those of routine MR imaging, non-contrast MR angiography, and X-ray intra-arterial DSA. Major cerebral arteries, all of the venous sinuses, and most tributaries were clearly visualized with 2D MRDSA. Also, pure arterial phases were obtained in all cases. The MRDSA technique demonstrated prolonged circulation in sinus thromboses, distal patent lumen of proximal occlusion, and some collateral circulation. Such hemodynamic information was comparable to that of intra-arterial DSA. Two-dimensional thick-slice MRDSA with high temporal resolution has a unique ability to demonstrate cerebral hemodynamics equivalent to that of intra-arterial DSA and may play an important role for evaluation of cerebrovascular occlusive diseases. Received: 16 November 1999; Revised: 27 June 2000; Accepted: 29 June 2000     

Assessment of the arteriovenous cerebrovascular system by multi-slice CT : A single-bolus, monophasic protocol

Purpose: We present a protocol for the non-invasive angiographic assessment of the arterial and venous cerebrovascular (CV) system by multi-slice CT.Material and Methods: Data acquisition was performed in a multi-slice CT scanner with a scan range from the carotid bifurcation to the vertex and manual scan start following i.v. administration of 120 ml iodinated contrast medium with a flow rate of 4 ml/s. This protocol was applied in 12 patients with symptoms of acute CV insuffiency.Results: In all patients, comprehensive imaging of the arteriovenous CV system was achieved including the common carotid bifurcation, the third segment of the major cerebral arteries, the dural sinus and the internal cerebral veins. Various CV pathologies, such as a territorial artery occlusion, a thrombotic obstruction of the internal carotid artery, an intracranial arteriovenous malformation and a sinus vein thrombosis, were successfully evaluated.Conclusion: Comprehensive assessment of the arteriovenous CV system is possible by the use of a single-bolus, monophasic multi-slice scan technique.     

Three-dimensional MR digital subtraction angiography using parallel imaging and keyhole data sampling in cerebrovascular diseases: initial experience

We assessed the feasibility of MR digital subtraction angiography (DSA) using parallel imaging and keyhole data sampling in the diagnosis of cerebrovascular diseases (CVDs) in 11 patients. Their diseases included arterial trunk stenosis/occlusion (n=4), aneurysm (n=3), arteriovenous malformation (n=2), venous angioma (n=1), and sinus thrombosis (n=1). The technique depicted not only anatomical features, comparably to MR angiography (n=10/11), but also hemodynamics such as collateral flow at a temporal resolution of 1.68 s/frame. When compared with conventional angiograms (n=7), details were missed in four patients (incomplete demonstration of aneurysmal neck in two and poor separation of AVM components in two). Although inferior to conventional angiography, this technique can provide both anatomical and hemodynamic information of CVDs.