CAJ | 학술논문

目的：探讨常规MRI、MR血管成像（MRA）和高分辨MRI诊断致缺血性卒中的颅内动脉夹层（IAD）的价值。方法前瞻性连续纳入59例于2008年8月至2015年4月在中山大学附属第一医院神经科住院的IAD致缺血性卒中患者[年龄（45±15）岁，男41例]。所有患者接受常规头部MRI／MRA检查，对其中25例行全脑DSA检查，对10例行高分辨MRI。分析IAD的常规MRI／MRA和高分辨MRI表现。对行DSA的患者，比较DSA与常规MRI／MRA对典型夹层征象的检出及符合率。结果（1）59例中，常规MRI／MRA检测到42例（71.2％）典型夹层征象，其中以壁内血肿（52.4％，22例）最常见，其他征象包括内膜征／双腔征（31.0％，13例）和长段不规则或丝线样狭窄（21.4％，9例）；而夹层动脉瘤（16.7％，7例）和鼠尾状闭塞（7.1％，3例）相对少见；常规MRI／MRA未检测到典型夹层征象的17例（28.8％）IAD中，夹层累及大脑中动脉（64．7％，11／17）较常规MRI／MRA检测到典型夹层征象的42例IAD（23．8％，10／42）更为多见，差异有统计学意义（χ2＝11．325，P＝0.006）。（2）25例接受DSA检查的患者中，15例（60．0％）有典型夹层征象；而常规MRI／MRA仅检测到其中8例（32．0％）有典型夹层征象，但差异无统计学意义（P＝0.088）。（3）有10例（16.9％）IAD常规MRI／MRA和DSA均显示非特异性局限性狭窄或截断样闭塞，而高分辨MRI检测到其中5例有内膜征，4例有壁内血肿，1例有内膜征和壁内血肿。结论常规头部MRI／MRA是检测IAD的有效技术，而高分辨MRI在诊断其他血管影像学检查无典型夹层表现的IAD方面独具优势。
목적：탐토상규MRI、MR혈관성상（MRA）화고분변MRI진단치결혈성졸중적로내동맥협층（IAD）적개치。방법전첨성련속납입59례우2008년8월지2015년4월재중산대학부속제일의원신경과주원적IAD치결혈성졸중환자[년령（45±15）세，남41례]。소유환자접수상규두부MRI／MRA검사，대기중25례행전뇌DSA검사，대10례행고분변MRI。분석IAD적상규MRI／MRA화고분변MRI표현。대행DSA적환자，비교DSA여상규MRI／MRA대전형협층정상적검출급부합솔。결과（1）59례중，상규MRI／MRA검측도42례（71.2％）전형협층정상，기중이벽내혈종（52.4％，22례）최상견，기타정상포괄내막정／쌍강정（31.0％，13례）화장단불규칙혹사선양협착（21.4％，9례）；이협층동맥류（16.7％，7례）화서미상폐새（7.1％，3례）상대소견；상규MRI／MRA미검측도전형협층정상적17례（28.8％）IAD중，협층루급대뇌중동맥（64．7％，11／17）교상규MRI／MRA검측도전형협층정상적42례IAD（23．8％，10／42）경위다견，차이유통계학의의（χ2＝11．325，P＝0.006）。（2）25례접수DSA검사적환자중，15례（60．0％）유전형협층정상；이상규MRI／MRA부검측도기중8례（32．0％）유전형협층정상，단차이무통계학의의（P＝0.088）。（3）유10례（16.9％）IAD상규MRI／MRA화DSA균현시비특이성국한성협착혹절단양폐새，이고분변MRI검측도기중5례유내막정，4례유벽내혈종，1례유내막정화벽내혈종。결론상규두부MRI／MRA시검측IAD적유효기술，이고분변MRI재진단기타혈관영상학검사무전형협층표현적IAD방면독구우세。
Objective To investigate the values of conventional magnetic resonance imaging (MRI),magnetic resonance angiography (MRA),and high-resolution MRI for diagnosing intracranial arterial dissection (IAD)caused ischemic stroke. Methods From August 2008 to April 2015,59 consecu-tive patients (age 45 ±15years,41males)with IAD caused ischemic stroke admitted to the First Affiliated Hos-pital of Sun Yat-Sen University were enrolled prospectively. All patients underwent conventional cranial MRI/MRA examination,25 of them underwent whole brain DSA examination,and 10 underwent high-resolution MRI. The findings of conventional MRI/ MRA and high-resolution MRI of IAD were analyzed. For patients undergoing DSA,the proportions of detection and compliance of IAD were compared between DSA and conventional MRI / MRA. Results (1)Conventional MRI / MRA revealed typical sign of artery dissection in 42 patients (71. 2%),among them,the intramural hematoma (n = 22,52. 4%)was most common. Other common signs included intimal flap/ double lumen sign (n = 13,31. 0%)and long irregular or thread-like stenosis (n = 9,21. 4%);while dissecting aneurysm (n = 7,16. 7%)and rat tail-shaped occlusion (n = 3, 7. 1%)were relatively rare. In 17 patients (28. 8%)with IAD that conventional MRI/ MRA did not detect the typical dissection sign,the dissections were involved in the middle cerebral artery (11 / 17,64. 7%), they were more common than the 42 patients with IAD (10 / 42,23. 8%)detected the typical dissection sign by conventional MRI/ MRA. There was significant difference (P = 0. 006). (2)Among the 25 patients undergoing DSA,DSA revealed that 15 patients (60%)had the typical dissection sign,and conventional MRI/ MRA only revealed 8 of them (32%)with the typical dissection sign,but there was no significant difference (P = 0. 088). In 15 patients with IAD that DSA detected the typical dissection sign;conventional MRI / MRA detected the typical dissection sign in 8 of them. The diagnostic coincidence rate was 8 / 15. (3)Both conventional MRI/ MRA and DSA revealed non-specific limitation stenosis or cut-off occlusion in 10 patients (16. 9%)with IAD,while the high-resolution MRI revealed intimal flap in 5 of them,intramural hematoma in 4,and intimal flap and intramural hematoma in 1. Conclusion Conventional cranial MRI/MRA is an effective technique for revealing IAD,whereas high-resolution MRI has the unique advantages for diagnosing IAD without typical dissection in other vascular imaging.