主动脉弓上磁共振血管成像在缺血性脑卒中临床应用的意义

Clinical value of CE-neck MRA in patients with ischemic cerebrovascular diseases

目的:应用主动脉弓上对比剂增强磁共振血管成像(CE-MRA)评价缺血性脑卒中患者的血管病变分布和狭窄程度,并探讨其在脑卒中高危患者诊断、治疗及预防中的意义。方法:回顾性分析2012年1月至12月收治的454例缺血性脑卒中患者的头颅MRI、头颅MRA及主动脉弓上CE-MRA影像及病史资料。结果:454例患者中,除85例(18.72%)未见颅外血管异常,其余369例患者发现513处颅外血管狭窄或闭塞,大部分患者存在多处或多支血管病变,平均1.43处/例(482/338)。多发病变中颈动脉系统病变占52.28%(252/482),椎基底动脉系统病变占47.72%(230/482),其中重度狭窄18处,闭塞患者17处,轻度狭窄占绝大多数93.18%(478/513)。颅内MRA检查阴性的患者中有62.67%存在颅外血管病变,且与颅内、颅外皆无血管病变组在梗死面积及程度方面存在显著统计学差异(P<0.01)。结论:主动脉弓上CE-MRA在缺血性脑卒中患者中的狭窄和闭塞检出率较高,且即使患者颅内MRA显示为阴性,但在有症状及明确颅内缺血病灶的情,况下仍应行主动脉弓上CE-MRA筛查,以发现潜在的颅外段血管病变,并及时进行相关治疗或者预防干预措施。

Objective： To evaluate the distribution and degree of stenosis of diseased vessels by contrast-enhanced MRA （CE-MRA） of upper arcus aorta in patients with ischemic cerebrovascular diseases （ICVD）, especially in high risk patients. Methods： The clinical and neuro-imaging （brain MRI, intra- and extracranial MRA） data from 454 patients （from Jan, 2012 to Dec, 2012） with ICVD were retrospectively analyzed. Results： Eight- five patients with ICVD did not have extracranial artery stenosis, the other 369 patients had 513 extracranial artery stenosis lesions in different degrees. CE-MRA images showed that most patients had more than one artery stenosis lesion, with an average of 1.43 lesions per patient （482/338）; 52.28% of the lesions were in the carotid artery system （252/482）,while 47.72% were in the basilar artery system （230/482）. Severe stenosis and occlusion accounted for 18 and 17 cases, respectively, while mild to moderate stenosis comprised the majority （93.18%, 478/513）. 62.67% of the patients without MRA intracranial artery stenosis had extracranial artery stenosis, and there were significant differences in area and degree of infarct between these patients and those who had no artery stenosis lesion both intra- and extracranially. Conclusions： CE- neck MRA has a high positive rate in detecting artery stenosis, especially the extracranial artery stenosis, and might play a crucial role in the diagnosis, treatment and prevention of ICVD.