Moyamoya病的MRI和MRA诊断(附15例报告)

MRI and MRA Diagnosis of Moyamoya Disease: A report of 15 Cases

目的：探讨ＭＲＩ和ＭＲＡ对Ｍｏｙａｍｏｙａ病的诊断价值。材料与方法：１５例Ｍｏｙａｍｏｙａ病患者中男６例，女９例。年龄４～４９岁，２０岁以下者１１例。应用Ｓｉｅｍｅｎｓ１．０Ｔ超导型ＭＲ系统（Ｉｍｐａｃｔ）行ＳＥ序列ＭＲＩ和三维时间飞跃法（３ＤＴＯＦ）ＭＲＡ。均有ＳＥ序列Ｔ１ＷＩ和Ｔ２ＷＩ，１４例有３ＤＴＯＦＭＲＡ，１例有ＤＳＡ，６例有平扫ＣＴ。选择２０例ＭＲＩ和ＭＲＡ正常者作为对照组。结果：ＭＲＩ均见丘脑基底节区（单侧３例，双侧１２例）有扩张的流空血管（Ｍｏｙａｍｏｙａ血管），其中１０例Ｔ２ＷＩ鞍上池有明确的异常血管网。１４例ＭＲＡ和１例ＤＳＡ均见颈内动脉（ＩＣＡ）上段或大脑中动脉（ＭＣＡ）、大脑前动脉（ＡＣＡ）近端闭塞以及丘脑基底节区的Ｍｏｙａｍｏｙａ血管，这些病理血管分布与ＳＥ序列ＭＲＩ所见一致。对照组ＭＲＩ和ＭＲＡ均见不到丘脑基底节区正常细小的穿支血管。６例有ＣＴ者仅２例可疑有Ｍｏｙａｍｏｙａ血管。结论：ＭＲＩ和ＭＲＡ是诊断Ｍｏｙａｍｏｙａ病的有效非创伤性方法。ＭＲＡ尚适用于随诊Ｍｏｙａｍｏｙａ病的演变、血管旁路术后血管再通情况以及高危人群普查。ＭＲＩ诊断Ｍｏｙａｍｏｙａ病优于平扫ＣＴ。

Objective: To explore the diagnostic value of MRI and MRA for Moyamoya disease.Materials and Methods:15 patients with Moyamoya disease (male 6, female 9) were studied, age ranged from 4 to 49 years, among which, 11 cases were less than 20 years old. SE sequence MRI (n=15) and 3D TOF MRA (n=14) were carried out with a 1.0T superconductive MR unit (Impact, Siemens), with noncontrast CT study in 6 cases and DSA in one. Meanwhile there were 20 normal MRI and MRA cases studied as a control group.Results:Low intensity Moyamoya vessels which were located in thalamusbasal ganglia region (3 unilateral and 12 bilateral) were noted on T1WI and T2WI in all case. Moyamoya vessels of the suprasellar cisterna were seen clearly on T2WI in 10 of 15 cases. Stenosis or occlusion of the bifurcation of ICA, proximal portion of the ACA or MCA, and Moyamoya vessels of thalamusbasal ganglia region were demonstrated by MRA (n=14) and DSA (n=1). These pathological vessels found on MAR and DSA were also correlated with SE sequence MRI to a great extent. Normal perforating arteries of thalamusbasal ganglia region couldn't be seen obviously on MRI and MRA in a control group. Only 2 of 6 cases with noncontrast CT were suspected as Moyamoya disease.Conclusion: MRI with MRA is an effective noninvasive method for the diagnosis of Moyamoya disease. MRA is suitable for screening test in high risk subjects, as well as followup studies for development and postsurgical bypass patency in Moyamoya disease. MRI is superior to noncontrast CT in diagnosing Moyamoya disease.