颈椎创伤继发椎动脉损伤核磁共振血管成像诊断及实验研究

MRA diagnosis and experiment study of vertebral artery injury following closed cervical spinal trauma

目的 探讨二维时间飞逝效应核磁共振血管成像（2D TOF MRA）对闭合性椎动脉损伤的诊断价值。方法 319例闭合性颈椎创伤患者，采用2D TOF MRA技术进行椎动脉前瞻性检查。14只犬建立颈椎屈曲损伤的撞击伤模型，撞击后摄X线片，24～36h后行椎动脉2D TOF MRA检查及椎动脉血管造影。结果 319例颈椎创伤患者中，52例伴有椎动脉损伤。单侧椎动脉损伤51例，左侧22例，右侧29例；双侧椎动脉损伤1例。14只犬均造成颈椎小关节脱位，MRA检查7只犬一侧椎动脉损伤；2只犬一侧椎动脉成像不完整，MRA诊断为可疑阳性；5只犬双侧椎动脉正常。血管造影显示，8只犬一侧椎动脉损伤，6只犬正常。MRA诊断为阳性的7只犬和阴性的5只犬，血管造影与之一致。MRA诊断为可疑阳性的2只犬，血管造影证实1只为阳性，另1只为阴性。结论 2D TOF MRA检查是诊断闭合性椎动脉损伤可靠、首选的方法，对血管痉挛和小面积内膜损伤尚难以准确鉴别。

Objective To evaluate the value of 2-dimensional time-of-flight MR angiography （2D TOF MRA） diagnosis of closed vertebral artery injury. Methods A total of 319 patients with closed cervical spinal trauma underwent 2D TOF MRA prospective examination. Flexion injury model of cervical spine impacted by flexion stunk force was established in 14 adult dogs. The cervical spine radio- graphy was taken immediately after injury. 2D TOF MRA was done in 24-36 hours. Results Vertebral artery injury was diagnosed by 2D TOF MRA in 52 of the 319 patients. Of the 52 patients, there were 51 unilateral vertebral artery injury, and 1 bilateral vertebral artery injury. The injury on the left was in 22 patients, and on the right in 29 patients. In animal experiment, cervical facet dislocation occurred in the 14 dogs. Seven dogs had unilateral vertebral artery injury by 2D TOF MRA examination. Two dogs had incomplete vertebral artery blood flow image in one side which was diagnosed as suspect positive. Five dogs had no vertebral artery injury. In angiograph examination, vertebral artery injury was found in 8 dogs, 6 dogs had no vertebral artery injury. Angiography found positive MRA diagnosis in 7 dogs and negative MRA diagnosis in 5 dogs. In 2 dogs with suspect MRA diagnosis, one was found positive and one negative by angiograph. Conclusion Prospective 2D TOF MRA examination is an effective, method for closed vertebral artery injury. While MRA may have less sensitivity to detect the spasm and small disruption of intima of vertebral artery.