高分辨磁共振成像在颈部动脉夹层致脑卒中诊断及随访研究中的价值

The value of high-resolution magnetic resonance imaging in the diagnosis and follow-up study of stroke caused by cervical artery dissection

目的总结颈部动脉夹层(CAD)所致脑卒中患者的高分辨磁共振成像(HR-MRI)特点和应用价值。方法收集2017年12月至2021年6月首都医科大学附属北京朝阳医院CAD所致的急性缺血性脑卒中的6例患者的临床及影像学资料,所有患者均经HR-MRI确诊并随访。结果患者年龄29~45岁,男性6例,均急性起病,3例存在诱因。临床表现为头晕4例,言语不利3例,肢体无力2例,视物模糊、肢体麻木、吞咽困难、颈部疼痛各1例。影像学检查显示颈内动脉夹层3例,病变均位于大脑中动脉供血区,椎动脉夹层3例,病变位于小脑及丘脑。首次HR-MRI检查均可见高信号血肿,3例可见内膜瓣或双腔。随访HR-MRI显示4例血肿完全吸收,1例大部分机化,1例未见吸收。治疗后,6例患者均预后良好,结论HR-MRI能够直观显示壁内血肿及内膜瓣等夹层的直接征象,可用于颈部动脉夹层的诊断及随访。

Objective To summarize the high-resolution magnetic resonance imaging(HR-MRI)features of stroke patients caused by cervical artery dissection(CAD).Methods Clinical and imaging data were collected from 6 patients admitted to Beijing Chao-Yang Hospital,Capital Medical University due to acute ischemic stroke caused by cervical artery dissection from December 2017 to June 2021.All patients were confirmed by HR-MRI and followed up with HR-MRI.Results The patients were aged from 29 to 45 years,all males and acute onset,with obvious inducement in three among them.The clinical manifestations were dizziness in 4 cases,speech impairment in 3 cases,limb weakness in 2 cases,blurred vision,limb numbness,dysphagia,and neck pain in 1 case each.Imaging examination showed internal carotid artery dissection in 3 cases,with lesions located in the middle cerebral artery area,and vertebral artery dissection in another 3 cases,with lesions located in the cerebellum and thalamus.HR-MRI examination showed intramural high signal hematoma in all 6 cases,with 3 cases showed intimal flap or double lumen.Follow up HR-MRI showed complete absorption of the hematoma in 4 cases,organized in 1 case,and no absorption in 1 case.After treatment,all 6 patients had a good prognosis.Conclusion HR-MRI can visually display intramural hematoma and the visual signs of dissection.HR-MRI can be used for the diagnosis and follow-up of cervical arterial dissection.