中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
7期
539-543
,共5页
陈忠华%熊越%虞晓菁%龚向阳
陳忠華%熊越%虞曉菁%龔嚮暘
진충화%웅월%우효정%공향양
颈动脉狭窄%磁共振成像
頸動脈狹窄%磁共振成像
경동맥협착%자공진성상
Carotid stenosis%Magnetic resonance imaging
目的 探讨MRI颅内高信号血管征(HVS)与颈内动脉(ICA)狭窄的相关性,观察颈动脉内膜剥脱术(CEA)对HVS的影响.方法 回顾性分析491例均行头颈联合CTA及头颅MRI液体衰减反转恢复序列(FLAIR)检查患者的影像资料,并对其41例CEA患者的术前术后影像资料进行对照分析.根据头颈联合CTA影像,将患者分为ICA狭窄组(177例)及ICA无狭窄组(314例),ICA狭窄组进一步分为单侧ICA狭窄组(132例)及双侧ICA狭窄组(45例).采用x2检验分析ICA狭窄组与ICA无狭窄组、单侧ICA狭窄组与双侧ICA狭窄组之间HVS的阳性率差异.在单侧ICA狭窄组中,根据ICA狭窄程度分为7个等级,即＜50％(40例)、50％～ ＜60％(15例)、60％ ～ ＜70％(17例)、70％～＜80％(6例)、80％ ～ ＜90％(7例)、90％～＜100％(23例)、100％(24例),采用Spearman等级相关分析HVS阳性率与ICA程度之间的相关性.对照分析41例CEA患者手术前后MRI FLAIR图像,观察HVS的变化.结果 491例患者中HVS阳性140例,HVS阴性351例.ICA狭窄组177例,其中HVS阳性81例;ICA无狭窄组314例,其中HVS阳性59例.ICA狭窄组HVS阳性率45.76％(81/177),ICA无狭窄组HVS阳性率18.79％(59/314),2组间HVS的阳性率差异有统计学意义(x2=40.40,P＜0.01).单侧ICA狭窄组HVS阳性率44.70％(59/132),双侧ICA狭窄组HVS阳性率48.89％(22/45),2组之间HVS阳性率差异无统计学意义(x2=0.24,P＞0.05).单侧ICA狭窄组ICA狭窄程度各等级的HVS阳性率依次为20.00％(8/40)、26.67％(4/15)、35.29％(6/17)、33.33％(2/6)、42.86％(3/7)、69.57％(16/23)、83.33％(20/24),HVS阳性率与ICA狭窄程度呈显著正相关关系(r=0.964,P＜0.01).CEA术前22例HVS阳性,术后19例(86.36％)HVS消失,HVS仍然存在的3例与CEA手术部位远端的血管狭窄有关.结论 MR颅内FLAIR序列出现HVS提示ICA存在严重狭窄,进一步针对颈部ICA的评估是非常必要的.CEA术后HVS消失,可能成为评估CEA手术效果的有效指标之一.
目的 探討MRI顱內高信號血管徵(HVS)與頸內動脈(ICA)狹窄的相關性,觀察頸動脈內膜剝脫術(CEA)對HVS的影響.方法 迴顧性分析491例均行頭頸聯閤CTA及頭顱MRI液體衰減反轉恢複序列(FLAIR)檢查患者的影像資料,併對其41例CEA患者的術前術後影像資料進行對照分析.根據頭頸聯閤CTA影像,將患者分為ICA狹窄組(177例)及ICA無狹窄組(314例),ICA狹窄組進一步分為單側ICA狹窄組(132例)及雙側ICA狹窄組(45例).採用x2檢驗分析ICA狹窄組與ICA無狹窄組、單側ICA狹窄組與雙側ICA狹窄組之間HVS的暘性率差異.在單側ICA狹窄組中,根據ICA狹窄程度分為7箇等級,即＜50％(40例)、50％～ ＜60％(15例)、60％ ～ ＜70％(17例)、70％～＜80％(6例)、80％ ～ ＜90％(7例)、90％～＜100％(23例)、100％(24例),採用Spearman等級相關分析HVS暘性率與ICA程度之間的相關性.對照分析41例CEA患者手術前後MRI FLAIR圖像,觀察HVS的變化.結果 491例患者中HVS暘性140例,HVS陰性351例.ICA狹窄組177例,其中HVS暘性81例;ICA無狹窄組314例,其中HVS暘性59例.ICA狹窄組HVS暘性率45.76％(81/177),ICA無狹窄組HVS暘性率18.79％(59/314),2組間HVS的暘性率差異有統計學意義(x2=40.40,P＜0.01).單側ICA狹窄組HVS暘性率44.70％(59/132),雙側ICA狹窄組HVS暘性率48.89％(22/45),2組之間HVS暘性率差異無統計學意義(x2=0.24,P＞0.05).單側ICA狹窄組ICA狹窄程度各等級的HVS暘性率依次為20.00％(8/40)、26.67％(4/15)、35.29％(6/17)、33.33％(2/6)、42.86％(3/7)、69.57％(16/23)、83.33％(20/24),HVS暘性率與ICA狹窄程度呈顯著正相關關繫(r=0.964,P＜0.01).CEA術前22例HVS暘性,術後19例(86.36％)HVS消失,HVS仍然存在的3例與CEA手術部位遠耑的血管狹窄有關.結論 MR顱內FLAIR序列齣現HVS提示ICA存在嚴重狹窄,進一步針對頸部ICA的評估是非常必要的.CEA術後HVS消失,可能成為評估CEA手術效果的有效指標之一.
목적 탐토MRI로내고신호혈관정(HVS)여경내동맥(ICA)협착적상관성,관찰경동맥내막박탈술(CEA)대HVS적영향.방법 회고성분석491례균행두경연합CTA급두로MRI액체쇠감반전회복서렬(FLAIR)검사환자적영상자료,병대기41례CEA환자적술전술후영상자료진행대조분석.근거두경연합CTA영상,장환자분위ICA협착조(177례)급ICA무협착조(314례),ICA협착조진일보분위단측ICA협착조(132례)급쌍측ICA협착조(45례).채용x2검험분석ICA협착조여ICA무협착조、단측ICA협착조여쌍측ICA협착조지간HVS적양성솔차이.재단측ICA협착조중,근거ICA협착정도분위7개등급,즉＜50％(40례)、50％～ ＜60％(15례)、60％ ～ ＜70％(17례)、70％～＜80％(6례)、80％ ～ ＜90％(7례)、90％～＜100％(23례)、100％(24례),채용Spearman등급상관분석HVS양성솔여ICA정도지간적상관성.대조분석41례CEA환자수술전후MRI FLAIR도상,관찰HVS적변화.결과 491례환자중HVS양성140례,HVS음성351례.ICA협착조177례,기중HVS양성81례;ICA무협착조314례,기중HVS양성59례.ICA협착조HVS양성솔45.76％(81/177),ICA무협착조HVS양성솔18.79％(59/314),2조간HVS적양성솔차이유통계학의의(x2=40.40,P＜0.01).단측ICA협착조HVS양성솔44.70％(59/132),쌍측ICA협착조HVS양성솔48.89％(22/45),2조지간HVS양성솔차이무통계학의의(x2=0.24,P＞0.05).단측ICA협착조ICA협착정도각등급적HVS양성솔의차위20.00％(8/40)、26.67％(4/15)、35.29％(6/17)、33.33％(2/6)、42.86％(3/7)、69.57％(16/23)、83.33％(20/24),HVS양성솔여ICA협착정도정현저정상관관계(r=0.964,P＜0.01).CEA술전22례HVS양성,술후19례(86.36％)HVS소실,HVS잉연존재적3례여CEA수술부위원단적혈관협착유관.결론 MR로내FLAIR서렬출현HVS제시ICA존재엄중협착,진일보침대경부ICA적평고시비상필요적.CEA술후HVS소실,가능성위평고CEA수술효과적유효지표지일.
Objective To evaluate the correlation between intracranial hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery(FLAIR) and the degree of the stenosis of internal carotid artery (ICA).The effect of carotid endarterectomy(CEA) on HVS was assessed.Methods A retrospective analysis of MR FLAIR sequence and cerebral-cervical computed tomography angiography(CTA) was performed in 1 total of 491 patients.Of the 491 patients,41 treated with CEA were evaluated using their pre-and post-operative image data.Patients were divided into ICA stenosis group and non-stenosis group according to the CTA imaging findings.The ICA stenosis group was subdivided into unilateral group and bilateral stenosis group.Furthermore,we measured and graded the ICA of the unilateral stenosis group into seven stenotic degrees,they were＜50％(n=40),50％-＜60％(n=15),60％-＜70％(n=17),70％-＜80％ (n=6),80％-＜90％ (n=7),90％-＜100％ (n=23),100％ (n=24),respectively.Chi square test was used to analyze the occurrence rates of HVS between ICA stenosis and non-stenosis group,and between ICA unilateral and bilateral stenosis group,respectively.Spearman rank correlation was performed to evaluate the correlation between the presence of HVS and stenotic degrees of the ICA.For the 41 patients who underwent CEA,pre-and post-operative image data were compared,focusing on the presence or disappearance of the HVS on MR FLAIR imaging.Results HVS on FLAIR images were observed in 81 of 177 patients(45.76％) with ICA stenosis,and in 59 of 314 patients(18.79％) without ICA stenosis.The occurrence rate of HVS was significantly higher in patients with ICA stenosis than those without ICA stenosis (x2=40.40,P＜0.01).There was no statistical significance in the occurrence rates of HVS between ICA unilateral stenosis group and bilateral stenosis group(x2=0.24,P＞0.05).The occurrence rates of HVS of ICA graded as the seven stenotic degrees were 22.00％(8/40),26.67％(4/15),35.29％(6/17),33.33％ (2/6),42.86％ (3/7),69.57％ (16/23),83.33％ (20/24),respectively.There was a significant positive correlation between the occurrence rates of HVS and the degrees of ICA stenosis(r=0.964,P＜0.01).HVS disappeared in 19(86.36％) out of 22 patients with HVS on pre-operative MR images after CEA in The remaining HVS in 3(13.64％) patients was attributed to the failure of completely recanalization of ICA.Conclusions A close relationship exists between HVS and ICA stenosis.The presence of HVS indicates a high probability of the existence of severe ICA stenosis.A further assessment for ICA stenosis is warranted.HVS disappearance after successful CEA indicates that HVS can be a useful marker for the the evaluation of consequence associated with CEA.
