症状性脑动脉狭窄患者颅内侧支循环的多层CTA研究

Studies on intracranial collateral circulation with multi-slice CT angiography in patients with symptomatic cerebral artery stenosis

目的探讨症状性脑动脉狭窄患者颅内侧支循环的特点。方法收集2004年4月-2009年6月临床拟诊缺血性脑血管病患者94例,所有患者均行头颅CT血管造影(CTA)检查,运用CTA血管重组图像及其原始横轴位图像,分析脑动脉狭窄及颅内侧支循环的特点。结果共检出48例脑动脉狭窄[脑梗死29例,短暂性脑血管发作(TIA)18例,烟雾病1例]。14例脑动脉重度狭窄或闭塞患者中,脑梗死6例(大面积脑梗死4例、分水岭梗死2例),颅内侧支循环均较少,另有半卵圆中心小面积梗死1例、TIA 7例,均有丰富的颅内侧支循环。22例脑动脉轻中度狭窄患者可见多发腔隙性脑梗死,但狭窄血管与梗死部位无明确供血关系。1例烟雾病患者颅内侧支循环丰富,无脑梗死。结论颅内侧支循环对脑动脉重度狭窄或闭塞患者具有重要的代偿作用。头颅CTA对脑动脉狭窄及其颅内侧支循环的评价具有重要意义。

Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection（MIP） and volume rendering（VR） images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack（TIA） and 1 of moyamoya disease（MMD）.Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels（including massive cerebral infarction in 4 cases and watershed infarction in 2 cases）,and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.