CAJ | 학술논문

目的：分析成人型缺血性烟雾病综合征的多模式磁共振成像（ MRI）表现及其诊断价值。方法收集2012年3月—2014年2月吉林市人民医院诊治的10例成人型缺血性烟雾病综合征患者，回顾分析其MRI平扫、动脉自旋标记法（ASL）脑灌注成像（PWI）、磁敏感成像（SWI）、三维时间飞跃法（3D - TOF）磁共振血管成像（MRA）、匙孔技术四维增强MRA（4D-TRAK-MRA）、MRI增强（CE-MRI）结果。结果 MRI平扫显示双侧大脑前动脉（ ACA）、大脑中动脉（ MCA）的流空信号消失，基底核区出现烟雾状血管流空信号影以及柔脑膜高信号征；ASL-PWI显示ACA、MCA供血区脑血流量（ CBF）减低；SWI显示梗死区缺乏小静脉显影，代偿区柔脑膜周围有多发增粗的小静脉；3D-TOF-MRA直观显示双侧颈内动脉（ICA）末端和ACA、MCA起始端的狭窄或闭塞以及增粗延长的大脑后动脉和脑底部烟雾血管；4D-TRAK-MRA能动态全景显示头颈部血运情况和柔脑膜的侧支循环，对烟雾病综合征诊断分期准确率达90%（9/10）。结论多模式MRI不但可以反映脑实质和颅内血管的情况，而且能提供解剖形态学和功能学两方面的特征，可作为烟雾病综合征筛查、诊断及分期的一种有效的影像学无创检查方法。
목적：분석성인형결혈성연무병종합정적다모식자공진성상（ MRI）표현급기진단개치。방법수집2012년3월—2014년2월길림시인민의원진치적10례성인형결혈성연무병종합정환자，회고분석기MRI평소、동맥자선표기법（ASL）뇌관주성상（PWI）、자민감성상（SWI）、삼유시간비약법（3D - TOF）자공진혈관성상（MRA）、시공기술사유증강MRA（4D-TRAK-MRA）、MRI증강（CE-MRI）결과。결과 MRI평소현시쌍측대뇌전동맥（ ACA）、대뇌중동맥（ MCA）적류공신호소실，기저핵구출현연무상혈관류공신호영이급유뇌막고신호정；ASL-PWI현시ACA、MCA공혈구뇌혈류량（ CBF）감저；SWI현시경사구결핍소정맥현영，대상구유뇌막주위유다발증조적소정맥；3D-TOF-MRA직관현시쌍측경내동맥（ICA）말단화ACA、MCA기시단적협착혹폐새이급증조연장적대뇌후동맥화뇌저부연무혈관；4D-TRAK-MRA능동태전경현시두경부혈운정황화유뇌막적측지순배，대연무병종합정진단분기준학솔체90%（9/10）。결론다모식MRI불단가이반영뇌실질화로내혈관적정황，이차능제공해부형태학화공능학량방면적특정，가작위연무병종합정사사、진단급분기적일충유효적영상학무창검사방법。
Objective To investigate the performance of multi-mode MRI for adult patients with moyamoya disease ( MMD)and its diagnostic value. Methods 10 patients with MMD admitted to Jilin City People's Hospital from March 2012 to February 2014 were selected. The results of MRI plain scan,ASL-PWI,SWI,3D -TOF-MRA,4D -TRAK -MRA and MRI enhanced scan(CE-MRI). Results MRI plain scan showed that flow-void signs of anterior cerebral artery(ACA)and middle cerebral artery( MCA)disappeared,and flow-void signs of moyamoya vessels and leptomeninges high signals appeared in basal ganglia;ASL-PWI showed that the cerebral blood flow( CBF)was reduced in ACA and MCA;SWI showed that the imaging development of small vein was deficient in infarction area,and there were multiple enlarged small veins in leptomeninges of compensation area;3D-TOF-MRA directly showed that the stenosis or occlusion of the tail end of bilateral internal carotid artery( ICA)and head end of ACA and MCA,as well as the thickened and lengthened posterior cerebral artery( PCA)and moy-amoya vessels at the base of brain;4D-TRAK-MRA could show a dynamic panoramic image of blood supply in brain and neck and the collateral circulation of leptomeninges, and it had a accuracy of 90% ( 9/10 ) in diagnosing and grading MMD. Conclusion Multi-mode MRI can reflect the condition of brain parenchyma and intracranial blood vessel both in terms of morphology and function,which is regarded as an effective,non-invasive imaging methods for the screening,diagnosing and staging of MMD.