成人烟雾病27例多层螺旋CT征象分析

Clinical features and multi-slice CT analysis of adult Moyamoya disease

目的分析成人烟雾病的CT平扫及CT血管造影(CTA)特征,旨在提高对烟雾病的认识。方法 27例烟雾病患者均行CT平扫和CTA检查,在ADW4.3工作站上做容积再现(VR)、最大密度投影(MIP)和多平面容积重建(MPVR)。结果本组病例均为成人,年龄为21～67岁,平均44.3岁。缺血型9例,其中3例表现为多发病灶,1例显示软化灶,脑萎缩3例,脑实质无明显异常2例;出血性脑卒中18例,脑实质区出血7例,脑室出血6例,脑实质并脑室出血4例,蛛网膜下腔出血1例。CTA均清晰显示发生狭窄、闭塞的颈内动脉、Willis环血管近侧端以及明显增多、扩张的脑底部侧支血管影,其中双侧颈内动脉狭窄、闭塞12例,单侧2例,双侧大脑中动脉狭窄、闭塞9例,单侧3例,双侧大脑前、中动脉A1、M1段不同程度狭窄、闭塞1例。侧支血管表现为相应血管及其分支粗大、增多,迂曲延长。结论 CTA可显示烟雾病患者脑血管的病理特点,CT平扫可显示合并脑梗塞及出血。

Objective To analyze the CT scan and CT angiography （CTA） characteristics of adult moyamoya disease, combined with its clinical manifestations, so as to improve awareness of moyamoya disease. Methods 27 cases of moyamoya disease were examined by CT Scan and CTA examination. Volume reproducibility （VR）, maximum intensity pro jection （MIP） and multiplanar volume reconstruction （MPVR） were performed on an ADW4.3 workstation. Results The patients were all adults, aged 21 to 67 years old, with an average of 44.3 years. In these patients, 9 cases were found to be ischemic, including 3 cases of frequently occurring lesions, 1 case of malacia, 3 cases of brain atrophy, and 2 cases without brain parenchyma abnormal; 18 cases were found to be hemorrhagic stroke, including 7 cases of cerebral hemorrhage, 6 patients with intraventricular hemorrhage, 4 cases of parenchymal and intraventricular hemorrhage, and 1 case of subarachnoid hemorrhage. CTA all clearly showed the occurrence of stenosis, occlusion of the internal carotid artery, blood vessels proximal end of the circle of Willis, as well as their significantly increased number, and the expansion of the base of the brain collateral vessels shadow. In these scans, it was found 12 cases were bilateral internal carotid artery stenosis and occlusion, 2 cases were unilateral, 9 cases were double side of the middle cerebral artery occlusion, 3 cases were unilateral, and 1 case were bilateral anterior cerebral artery A1, M1 segment showed of different degree of stenosis and occlusion. The collateral vessels displayed as thicken and increased number of the corresponding blood vessels, and extended its branches tortuosity. Conclusion CT scan in conjunction with clinical manifestations is a promising method for diagnosis of moyamoya disease. Further use of CTA screening can provide definitive diagnosis. This technique has many advantages such as convenient, non-invasive, low-cost, easily accepted by patients, and intuitive and reliable reconstructed image, etc. It can fully display the pathological changes of moyamoya disease, and it is an efficient and practical diagnostic technique.