MRI和TCDU对早期脑动脉硬化症临床诊断价值的对比研究

Comparative study of MRI and TCD findings in early cerebral arteriosclerosis

目的:探讨早期脑动脉硬化患者的MRI和经颅多普勒超声(TCDU)表现及其在早期脑动脉硬化临床诊断中的应用价值。方法:将2011年10月-2012年9月在我院脑科中心同时行颅脑MRI和TCDU检查的81例患者,分为早期动脉硬化组(患者组)和无早期动脉硬化组(对照组)。常规MRI序列包括T1WI、T2WI、FLIAR,14例行MRS和MRA检查;TCDU检查包括大脑前、中、后动脉及椎基底动脉。对比分析MRI、TCDU对早期脑动脉硬化的诊断敏感性和特异性,观察颅内中小动脉硬化之间的关系及病变分布特点。结果:81例中临床诊断为早期脑动脉硬化者60例(74.1%),其中58例FLAIR像显示脑内多发斑点状高信号影(272处),主要分布于额叶(39.7%,108/272),其次为基底节区(22.8%,62/272);14例行多体素MRS检查,其中10例为脑动脉硬化患者,均表现为脑白质病变区域NAA和NAA/Cr、NAA/Cho、NAA/MI下降。89例中TCDU检查提示有病变者59例(72.8%),其中观察组52例(86.7%,52/60),显著高于对照组(33.3%,7/21)。颅内动脉病变和脑实质内异常信号病灶之间有明显相关性(P<0.05)。MRI、TCDU诊断早期脑动脉硬化的受试者工作特征(ROC)曲线下面积(AUC)分别为0.95±0.02和0.82±0.05,差异有统计学意义(P<0.01)。结论:MRI对早期脑动脉硬化的诊断准确性要高于TCDU,是早期脑动脉硬化影像学诊断的首选方法,TCDU可以作为早期脑动脉硬化的筛查手段。

Objective：To investigate the diagnostic value of magnetic resonance imaging （MRI）and transcranial doppler ultrasound （TCDU）findings in early stage cerebral arteriosclerosis.Methods：81 consecutive patients underwent both MRI and TCDU from October 2011 to September 2012.The patients were dividul in two groups：early cerebral arterio-sclerosis group （as the disease group）and non-early cerebral arteriosclerosis group （as the controll group）.All cases under-went routine MRI using T1 WI,T2 WI,FLAIR and MRA sequences,and MRS were performed in 14 cases.As for TCDU ex-amination,anterior cerebral artery （ACA）,middle cerebral artery （MCA）,posterior cerebral artery （PCA）,vertebral artery （VA）and basilar artery （BA）were observed.The sensitivity and specificity of MRI and TCDU in the diagnosis of early cerebral arteriosclerosis were comparatively analyzed,the relationships between small and medium sized vessels intracranial arteriosclerosis as well as lesion distribution were observed.Results：Sixty patients （74.1%,60/81）were diagnosed as early cerebral arteriosclerosis.58 cases of them showed multiple high intensity spots in the brain on FLAIR images,mainly in the frontal lobe （39.7%,108/272）,followed by the basal ganglia area （22.8%,62/272）.The values of NAA,NAA/Cr,NAA/Cho,NAA/MI in white matter lesions decreased on MRS in 10 cases of all 14 cases.TCDU showed that 59 cases （72.8%） had abnormal cerebral artery （52 cases in disease group and 7 cases in control group）.There was significant correlation be-tween cerebral artery lesions and abnormal signals in the brain parenchyma （P〈0.05）.To diagnose early cerebral arterio-sclerosis by MRI and TCDU,the area under ROC curve was 0.95±0.02、0.82±0.05 respectively,which had significant difference （P〈0.01）.Conclusion：In the diagnosis of early cerebral arteriosclerosis,MRI had a better diagnostic value than TCDU,and would be the preferred method to detect the early cerebral arteriosclerosis.TCDU can be used as the screening method.