Moyamoya病CT、MRI和DSA的诊断价值比较

Comparions of the diagnostic value of CT, MRI and DSA for Moyamoya disease

目的:比较CT、磁共振成像(MRI)和数字减影血管造影(DSA)对Moyamoya病的诊断价值。方法:对经临床和影像学证实的153例Moyamoya患者的CT、MRI及DSA进行回顾性分析。153例患者中,83例有CT平扫,30例有CT增强,25例有CT血管造影(CTA);135例有MRISE序列平扫,3D TOFMR血管成像(MRA)130例;113例有DSA。结果:83例CT平扫发现脑梗死38例,脑出血33例,仅3例隐约可见丘脑、基底节区和鞍上池的略高密度烟雾血管影;135例MRI平扫患者中发现脑梗死108例,脑出血38例。CT平扫、CTA、CT增强诊断阳性率分别为3.6%(3/83)、92%(23/25)和93.3%(28/30)。MRI平扫和3D TOFMRA的诊断阳性率分别为95.6%(129/135)和100%(135/135)。DSA诊断阳性率100%(113/113)。CTA、MRA和DSA显示颈外动脉侧支循环的阳性率分别为24%(6/25)、27.7%(36/130)和35.4%(40/113)。与DSA比较,CTA和MRA显示烟雾血管少,常高估脑动脉狭窄。结论:DSA是诊断烟雾病的最佳影像学手段,但具有创伤性。CT增强、CTA、MRI平扫和MRA均是诊断烟雾病的重要方法,CT平扫难以诊断烟雾病。

Aim ： To compare the diagnostic value of computed tomography （CT） , magnetic resonance imaging （MRI） and digital subtraction angiography（DSA） in Moyamoya disease. Methods：The CT, MRI and DSA materials of 153 patients with Moyamoya disease were retrospectively analysed. In these patients, 83 had plain CT scan, 30 had postcontrast CT scan, and 25 had computed tomographic angiography （CTA） ; 135 had precontrast MRI scan with SE sequence, 130 had 3 D time-of-fly magnetic resonance angiography （3 D-TOF MRA） ; 113 had DSA. Results： A trtal of 38 cases of infarction and 33 cases of hemorrhage were found in the 83 patients with plain CT scan, and slightly high density Moyamoya ves- sels were found in the thalamus-basal ganglia region and the suprasalle cistern in 3 of 83 cases. In the 135 patients with precontrast MRI scan, 108 cases of infarction and 38 cases of hemorrhage were demonstrated, respectively. The positive diagnostic rate of plain CT, CTA and precontrast,CT for Moyamoya disease diagnosis was 3.6% （3/83） , 92% （23/25） and 93.3% （28/30） , respectively . The positive diagnostic rate of precontrast MRI scan and 3D-TOF MRA was 95.6% （ 129/ 135） and 100% （135/135） , respectively. The positive diagnostic rate of DSA was 100% （113/113 ）. The positive rate of CTA, MRA and DSA for demonstrating collateral vessels from external carotid artery was 24% （6/25） , 27.7% （36/130） , and 35.4% （40/113） , respectively. Compared with DSA, CTA and MRA demonstrated fewer Moyamoya vessels and often overestimated the stenosis of cerebral arteries. Conclusion ： DSA is the best radiological method to diagnose moyamoya disease, but it has invasiveness. Postcontrast CT, CTA, precontrast MRI and MRA are important methods for the diagnosis of Moyamoya disease, but plain CT is difficult to make the diagnosis.