64排螺旋CT颅脑血管成像在诊断成人烟雾病中的应用价值

Diagnostic Value of 64-row Helical CT Angiography in Adult Moyamoya Disease

目的探讨64层螺旋CT脑血管成像（CTA）在成人烟雾病（Moyamoyadisease，MMD）诊断中的应用价值并分析其影像特征，提高对成人烟雾病的认识。方法收集22例烟雾病患者的临床资料及CTA影像学资料并进行回顾性分析，并对其中12例患者的DsA结果进行比较分析。结果脑卒中为该组成人烟雾病患者的主要临床表现，以出血性卒中为主，发生率为77％（17／22），其中脑实质区出血10例，脑室出血4例，脑实质并脑室出血3例，蛛网膜下腔出血（SAH）3例，其中1例发生多次SAH。缺血性卒中发生率23％（5／22），其中4例表现为脑梗死，1例脑实质无明显异常；CTA及后处理技术可清晰显示Willis环附近动脉狭窄或闭塞，脑底烟雾状血管网、侧枝循环及动脉瘤形成。与DSA结果对照，12例中除1例大脑中动脉远端小动脉瘤漏诊外，血管狭窄、闭塞及侧枝循环情况与DSA显示基本一致。结论CTA可显示烟雾病患者脑血管的病理特点，是明确诊断烟雾病的有效的非创伤性的首选检查方法，可替代DSA进行炯雾病的筛选、诊断和随访。

Objective To explore the diagnostic value of 64-row helical CT angiography（CTA） in adult moyamoya disease（MMD）,combined with its clinical manifestations to analyze the characteristics of CTA,so as to improve awareness of MMD.Methods Clinical data and CTA materials of 22 moyamoya patients were retrospectively analyzed,and 12 in 22 cases were compared ＇with the results of DSA.Results Stroke episodes especially hemorrhagic stroke were the main clinical manifestations with the occurrence rates of 77%（17/22）,including l0 cases of cerebral hemorrhage,4 patients with intraventricular hemorrhage,3 cases of parenchymal and intraventricular hemorrhage,and 3 cases of subarachnoid hemorrhage.23%（5/22） was ischemic stroke,4 cases of cerebral infarction,and 1 case without brain parenchyma abnormal.CTA all clearly showed the vascular stenosis or occlusion in the circle of Willis and collateral formed to compensate.Aneurysm formed in some cases.There is a high coincidence between CTA with DSA,except that one aneurysm was missed diagnosis in 12 cases.Conclusion CTA is a preferred,effective and noninvasive diagnostic method of MMD and it could replace DSA in screening,diagnosing and following up observation.