椎基底动脉夹层的临床与影像学特征分析

Clinical and neuroradiological features of vertebrobasilar artery dissection

目的探讨椎基底动脉夹层(VBAD)的临床特点及影像学特征。方法回顾性分析21例VBAD患者的临床表现、DSA检查结果、CTA/MRA阳性发现及颈部动脉彩色多普勒血流成像(color doplor flow image,CDFI)结果。结果 21例患者共识别出24处夹层病变。21例中,19例(90%)表现为后循环缺血症状、体征,其中后循环梗死占71%(15/21),短暂性脑缺血发作(TIA)占19%(4/21);经DSA和CTA确诊7例夹层动脉瘤,2例珠网膜下腔出血(SAH)。本组中,18例(86%)出现头痛、颈痛或头颈痛。本组DSA多见的异常表现为,线样征、夹层动脉瘤、串珠征和双腔征;CTA在发现线样征、串珠征和动脉瘤方面有帮助。与DSA比较,颈动脉CDFI可发现多数夹层病变的双腔结构和壁内血肿。结论 VBAD的主要临床特征是后循环缺血与梗死,多伴有头痛、颈痛或头颈痛。与夹层相关的动脉瘤可能并不少见。颈动脉CDFI检查对VBAD的诊断十分有益。

Objective To explore the clinical and neuroradiological features of vertebrobasilar artery dissection（VBAD）.Methods Clinical characteristics,DSA findings,CTA/MRA findings,results of color doplor flow image（CDFI）were investgated in a group of 21 patients with VBAD.Results Twenty-one patients with 24 dissecting lesions were identified.Postal circulation ischemia occurred in 19 patients（90%）,Among whom ischemic stroke（n=15,71%）,transient ischemic attack（n=4,19%）.Seven patients with dissecting aneurysm were conformed by DSA and CTA,and two of them showed signs of subarachnoid hemorrhage（SAH）.Eighteen patients with ischemia and SAH had head and（or）neck pain.DSA showed that dissecting aneurysm,string sign,pearl sign and dual-chamber sign were most common findings.CTA may be helpful in finding pearl and string signs and aneurysms.Compaired with DSA,CDFI could find most of dual-chambers and wall haematomas,but also showed less sensitivity in finding aneurysms.Conclusion The main clinical features of VBAD are postal circulation ischemia and stroke,most of them are companied by head and（or）neck pain.Dissecting aneurysm related with VBAD may be much more frequent than previously considered.Angiography may still be necessary for the definite diagnosis of VBAD,and CDFI may be valiable for detecting VBAD.