3.0 T MRI对儿童动脉性缺血性脑卒中的诊断价值

The diagnostic value of 3.0 T MRI in detecting childhood arterial ischaemic stroke

目的探讨MR的常规扫描序列、扩散加权成像(DWI)和非增强时间飞跃法血管成像(3D TOF MRA)对儿童动脉性缺血性脑卒中(arterial ischaemic stroke,AIS)的诊断价值。材料与方法对18例有临床症状且同时行MRI检查并确诊为AIS的患儿进行回顾性分析。所有患儿均同时行MR常规扫描序列(包括T1WI、T2WI和T2-FLAIR)、DWI和3D TOF MRA扫描。结果 18例患儿7例发病前有感染史,3例有外伤史,1例合并布卡综合征和先天性心脏病,1例合并唐氏综合征(21-三体综合征),1例有脑颜面血管瘤综合征。MRI共检出梗死灶53处,DWI示16例存在急性期病变。9例为多脑叶梗死,4例为大面积脑梗死,1例无脑梗死病灶。MRA检查示15例患儿存在血管狭窄或闭塞,8例为局限性的血管病变,7例为烟雾病。共检出血管狭窄34处,血管闭塞3处。结论 MR常规扫描序列和DWI结合非增强3D TOF MRA可全面评价儿童动脉性缺血性脑卒中的部位和血管狭窄的程度及发病时间。

Objective： To explore the diagnostic value of conventional MR sequence, DWI combination with 3D time-of-flight MR angiography （3D TOF MRA） in the childhood arterial ischaemic stroke. Materials and Methods： We retrospectively reviewed the MR images of 18 consecutive children with clinical symptom who underwent conventional MR sequence, DWI and 3D TOF MRA. Results： Of 18 children, 7 cases had a history of infection, 3 cases of trauma, 1 case of Budd-Chiari syndrome and congenital heart disease, 1 case with Down＇s syndrome and 1 case with Sturge-Weber syndrome. A total of 53 cerebral infarct lesions and 16 cases of apparent diffusion restricted in all patients were found on MR. Of all cases, 9 cases showed multiple infarctions, 4 cases showed massive cerebral infarction, and one case with no cerebral infarction. MRA results were abnormal in 15 children and normal in 3 children. Of the 15 children, 8 cases were focal cerebral arteriopathy and 7 cases were moyamoya disease. Thirty-four vascular stenoses and three vascular occlusions were detected in 15 patients. Conclusions： The combination of conventional MR sequence, DWI and 3D TOF MRA can be used to detect and identify the site of the artery stenosis and infarction and can provide more information about the timing of stroke events in childhood.