基底动脉尖综合征的MRI诊断及临床价值

MRI diagnosis and clinical significance of top of the basilar artery syndrome

目的探讨基底动脉尖综合征(TOBS)的MRI表现及临床应用价值。方法回顾我院临床确诊的21例TOBS的患者。全部经MRI扫描,行常规MRI、磁共振扩散加权成像(DWI)序列扫描,其中17例行三维空间飞跃法磁共振血管成像。分析病灶累及部位和各序列的MRI特征。结果MRI提示病灶发生在小脑(9例)、脑桥(6例)、丘脑(11例)、中脑(10例)、枕叶(7例)、颞叶内侧面及胼胝体压部(6例)等呈不同梗死部位的组合,梗死灶以长T1长T2信号为主要影像学特征,DWI全部显示为高信号;磁共振血管造影术显示为基底动脉、小脑上动脉及大脑后动脉闭塞或狭窄。17例患者治疗后随访14例DWI呈等信号,3例呈局限性低信号;所有病例在T2-FLAIR上呈高信号。结论 TOBS临床表现及体征是复杂多样的,可出现不同梗死部位的组合。T2-FLAIR、DWI和磁共振血管造影术对TOBS诊断及治疗中随访观察有很高的诊断价值,MRI可作为TOBS的首选影像诊断手段。

] Objective To study the MRI features and clinical significance of top of the basilar artery syndrome（TOBS）. Methods Twenty-one patients With TOBS who were proved clinically underwent magnetic resonance imaging （ MRI ）, and the image features and lesion characteristics were retrospectively analyzed. The MRI sequences included conventional MRI, diffusion weighted imaging （DWI）, and three dimensional time-of-flight（3D-TOF）. Results MRI showed the different parts of the infarction including cerebellum （ 9 cases） , pons （ 6 cases ） , thalami （ 11 cases ） , midbrain （ 10 cases ） , occipital lobe （ 7 cases ） , medial temporal lobe and splenium of corpus callosum （6 cases ）. All lesions showed long T1 and long T2 signal. Hyperintense signals were found on DWI in 21 cases. The features of magnetic resonance angiography （MRA） were occlusion or stenosis of basilar artery, superior cerebellar artery and posterior cerebral artery. After the treatment, the lesions presented isointensity in 14 cases, and hypointensity in 3 cases on DWI, and all lesions had hyperintensity on T2-FLAIR images. Conclusions The clinical manifestations and signs are complicated and the different parts of the infarction combined in TOBS. T2-FLAIR, DWI and MRA have important value in the diagnosis and follow-up during treatment. MRI is suggested to be the first choice in diagnosis of TOBS.