不同Mori分型椎动脉颅内段重度狭窄的彩色多普勒血流成像特点和血流动力学参数分析

Analysis of color doppler and hemodynamic parameters of severe intracranial vertebral artery stenosis with different Mori classifications

目的分析比较不同Mori分型颅内段椎动脉重度狭窄(SIVAS)的颅内、颅外段椎动脉彩色多普勒血流成像(CDFI)特点与血流动力学参数的差异。方法回顾性连续纳入2017年1月至2018年6月因症状性单侧SIVAS住院治疗的患者共122例(122支),通过CT血管成像或DSA影像,按照Mori分型的标准分为MoriA、B、C型,分别检测椎动脉狭窄段的CDFI血流特征、狭窄段与狭窄近段的收缩期峰值流速(PSV)、舒张期末流速(EDV)、平均流速(MFV)、血管搏动指数(PI)、阻力指数(RI)并进行分析比较。结果122例(122支)患者,MoriA型46例(46支),MoriB型55例(55支),MoriC型21例(21支)。不同Mori分型间患者年龄、性别、病变侧别和脑血管病危险因素如高血压病、糖尿病、高血脂、吸烟以及后循环供血区脑梗死发生率方面差异均无统计学意义(均P>0.05);MoriC型组平均病变长度[(16.0±6.3)mm]明显高于MoriB型[(7.0±1.6)mm]和MoriA型[(3.4±0.8)mm],差异有统计学意义(F=145.297,P<0.01)。MoriA型和B型颅内经颅彩色多普勒超声检测表现为狭窄段局限性血流充盈不全,血流束变细,呈“五彩相间”血流信号;MoriC型中12支(57.1%)椎动脉显示间断性血流成像或血流中断征。MoriC型椎动脉颅内段狭窄处及颅外段的PSV、EDV、MFV均明显低于A型和B型[颅内段:分别为34(8,198)cm/s比231(206,296)、234(205,294)cm/s,13(0,88)cm/s比107(85,143)、115(91,152)cm/s,19(3,128)cm/s比142(127,193)、155(129,196)cm/s;颅外段:分别为38(34,45)cm/s比50(41,58)、47(41,56)cm/s,8(7,13)cm/s比18(14,20)、17(12,24)cm/s,19(16,23)cm/s比28(23,33)、26(22,35)cm/s],PI值、RI值明显高于A型和B型[分别为0.98(0.78,1.26)比0.87(0.74,1.02)、0.78(0.71,0.90),0.75(0.68,0.82)比0.64(0.61,0.69)、0.64(0.59,0.71)],差异均有统计学意义(均P<0.017),而MoriA型与B型间各血流动力学参数差异均无统计学意义(均P>0.017),MoriC型病变中74.1%(15支)未达到重度狭窄的血流速度标准。结论SIVAS的MoriC型病变的局部彩色多普勒显像特点、颅内及颅外段血流动力学参数与MoriA型和B型病变存在差异,可表现为颅外段低速高阻和颅内段血流信号不连续的征象。

Objective To analyze and compare the intracranial and extracranial color doppler and hemodynamic parameters of severe intracranial vertebral artery stenosis (SIVAS) with different Mori classifications.Methods From January 2017 to June 2018,a total of 122 consecutive in-patients of symptomatic unilateral SIVAS were enrolled retrospectively in Xuanwu Hospital,Capital Medical University.They were divided into Mori A,B,and C groups according to the criteria of Mori classifications by CT Angiography or DSA images.Characteristics of color doppler flow imaging (CDFI) in vertebral stenosis segment and blood flow parameters of spectrum doppler,including peak systolic velocity (PSV),end-diastolic velocity (EDV),mean flow velocity (MFV),resistance index (RI) and pulsatility index (PI ) in both the stenosis segment and the proximal stenosis segment were detected and compared.Results Among 122 cases (122 branches),46 cases (46 branches) were Mori A type,55 cases (55 branches) were Mori B type and 21(21 branches) were Mori C type.There were no significant differences among different Mori types in ages,gender,lesion side,cerebrovascular disease risk factors such as hypertension,diabetes,hyperlipidemia and smoking and the incidence rate of posterior circulation infarction (all P >0.05).The average lesion length of Mori C group (16.0±6.3 mm) was significant longer than that of Mori B group (7.0±1.6 mm) and Mori A group (3.4±0.8 mm).The differences were statistically significant ( F =145.297,P <0.01).Transcranial color doppler ultrasound of Mori type A and type B showed incomplete and thinner local blood flow in the stenosis segment,presenting a “multicolored” signal.Twelve (57.1%) of Mori C type showed blood flow discontinuity or interruption.The PSV,EDV and MFV of the intracranial and extracranial segment of Mori C type SIVAS were significantly lower than those of type A and type B cases (intracranial segment:34[8,198]cm/s vs.231[206,296],234[205,294]cm/s;13[0,88]cm/s vs.107[85,143],115[91,152]cm/s;19[3,128]cm/s vs.142[127,193],155[129,196]cm/s respectively;extracranial segment:38[34,45]cm/s vs.50[41,58],47[41,56]cm/s;8[7,13]cm/s vs.18[14,20],17[12,24]cm/s;19[16,23]cm/s vs.28[23,33],26[22,35]cm/s respectively;all P <0.017),and the PI and RI values were significantly higher than those of type A and type B(0.98 [0.78,1.26] vs.0.87[0.74,1.02],0.78[0.71,0.90];0.75[0.68,0.82] vs.0.64[0.61,0.69],0.64[0.59,0.71];all P <0.017 ).There were no significant differences in all hemodynamic parameters between Mori type A and Mori type B (all P >0.017).About 74.1%(15) of Mori type C did not meet the hemodynamics criteria for severe stenosis.Conclusions Mori C type lesions of SIVAS differ from Mori A and B lesions in the local color imaging features,intracranial and extracranial hemodynamic parameters.Blood flow in Mori C type lesions can be manifested with low-velocity and high-resistance in extracranial segment and discontinuity in intracranial segment.