高分辨率MRI管壁成像对成人烟雾病的评估

Adult moyamoya disease: the value of high-resolution MRI of blood vessel wall

目的评估高分辨率磁共振管壁成像技术在双侧及单侧烟雾病管壁特征中评估及鉴别诊断的价值。方法 46例确诊的烟雾病患者(双侧31例,单侧15例)均进行高分辨率磁共振管壁成像扫描。描述性分析烟雾病患者的临床特征,并将临床及管壁特征与之相匹配的颅内大脑中动脉粥样硬化狭窄的患者的特征进行对照。结果颅内动脉粥样硬化患者更易合并高血脂及糖尿病,且血管外径、管壁厚度及重塑指数均高于烟雾病患者(P值均<0.001)。双侧及单侧烟雾病的血管外径及重塑指数无统计学差异,但单侧烟雾病的管壁厚度(0.30±0.01) mm小于双侧烟雾病(0.51±0.12) mm(P<0.001)。烟雾病更易累及颈内动脉末端分叉部,增强后颅内动脉粥样硬化强化多较明显,且多为偏心性强化。结论烟雾病具有不同于动动脉粥样硬化的管壁特征。单侧烟雾病的大部分管壁特征与双侧烟雾病相似,但管壁厚度较双侧小。

Objective To assess the value of high-resolution MRI in evaluation of the blood vessel wall of moyamoya disease. Methods Forty-six patients with moyamoya disease （31 bilateral and 15 unilateral） underwent high-resolution MRI. The clinical features and the vessel wall characteristics were compared to that of patients with middle cerebral artery atherosclerosis stenosis. Results Hyperlipidemia and diabetes mellitus were more common in atherosclerosis group. The outer wall diameter, wall thickness and concentric stenosis of atherosclerosis were all higher than that of moyamoya disease. There was no significant difference in outer wall diameter and concentric stenosis, whereas the vessel wall of unilateral moyamoya disease （0.30±0.01 mm） was significantly thinner （P〈0.001） than that of bilateral moyamoya disease （0.51±0.12 mm）. Moyamoya disease more commonly involved the internal carotid artery bifurcation than atherosclerosis. Vessel wall enhancement was more obvious and more eccentric in atherosclerosis. Conclusion Blood vessel wall characteristics of moyamoya disease differ from that of atherosclerosis with thinner wall in unilateral than bilateral moyamoya disease.