颈动脉蹼的CTA影像学与临床特征分析

Analysis of CTA image and clinical characteristics of carotid web

目的总结颈动脉蹼的计算机断层扫描血管造影(CTA)影像学特征,以期提高对颈动脉蹼的认识和诊断能力。方法回顾性分析2016年1月至2020年12月我科室经飞利浦256层螺旋极速CT(iCT)头颈部CTA检查的1436例患者的影像学与临床资料,以磁共振成像(MRI)检查作为颅内缺血性脑卒中诊断标准,结合患者的临床资料,分析颈动脉蹼的CTA特征以及与隐源性缺血性脑卒中的相关性。结果本研究共诊断出颈动脉蹼71例,发生率为4.94%(71/1436)。其中12例(16.90%)双侧(女5例,男7例),28例(39.44%)右侧(女11例,男17例),31例(43.66%)左侧(女13例,男18例)。颈动脉蹼发生部位为颈动脉球部68例(95.77%),颈内动脉C1中段附近3例(4.23%),余颈部动脉未发现明确蹼结构。颈动脉蹼走向:向上顺血流方向49例(69.01%),垂直(包括近似垂直)血管壁18例(25.35%),向下逆血流方向4例(5.63%)。颈动脉蹼的CTA表现形式一般分为两种:局限性凹陷;向腔内突入的光滑线样充盈缺损。6例患者CTA显示颈动脉蹼根部非钙化小斑块。13例患者MRI检查发现新近脑梗塞,39例患者发现陈旧性脑梗塞,12例患者无脑梗塞,另7例患者未进行MRI检查。52例脑梗塞患者中,48例存在缺血性脑卒中常见的致病危险因素(高血压、高脂血症、糖尿病、心脏病以及吸烟等)。结论颈动脉蹼具有显著的CTA影像学特征:轴位原始薄层图像及矢状位或斜矢状位显示为颈内动脉球部外后壁向腔内突入的光滑线样充盈缺损,是隐源性、复发性缺血性脑卒中的一个潜在病因。

Objective To summarize the computed tomography angiography(CTA)image characteristics of carotid web,in order to improve the understanding and diagnosibility of carotid web.Methods The imaging and clinical data of 1436 patients who underwent head and neck CTA with Philips 256 slice spiral fast CT(iCT)in our department from January 2016 to December 2020 were retrospectively analyzed.Combined with clinical data of patients,the CTA characteristics of carotid web and its correlation with cryptogenic ischemic stroke were analyzed based on the diagnosis of intracranial ischemic stroke by magnetic resonance imaging(MRI).Results A total of 71 cases of carotid web were diagnosed in this study,and the incidence was 4.94%(71/1436).Among them,12 cases(16.90%)were bilateral(5 women and 7 men),28 cases(39.44%)were right(11 women and 17 men),and 31 cases(43.66%)were left(13 women and 18 men).A total of 68 cases(95.77%)of carotid web occurred at the bulb of carotid artery,3 cases(4.23%)were near the middle segment of internal carotid artery C1,and no web structure was found in other cervical arteries.The direction of carotid web:49 cases(69.01%)in the direction of blood flow upward,18 cases(25.35%)in the direction of vertical(including nearly vertical)vascular wall,and 4 cases(5.63%)in the direction of blood flow downward.CTA manifestations of carotid web are generally divided into two types:localized depression;smooth linear filling defect protruding into the cavity.CTA showed non-calcified small plaques at the root of carotid web in 6 patients.New cerebral infarction was found in 13 patients,old cerebral infarction was found in 39 patients,no cerebral infarction was found in 12 patients,and MRI was not performed in the other 7 patients.Among 52 patients with cerebral infarction,48 had common risk factors for ischemic stroke(hypertension,hyperlipidemia,diabetes,heart disease,smoking,etc).Conclusion Carotid web has significant characteristics of CTA image:axial original thin-layer image and sagittal or oblique sagittal view show a smooth line-like filling defect with the outer posterior wall of the internal carotid bulb protruding into the cavitynd,it is a potential cause of cryptogenic and recurrent ischemic stroke.