小儿缺血性脑血管病的MRI及MRA诊断

Diagnosis of ischemic cerebrovascu lar disease in childhood with MR imag ing and MR angiography

目的评价磁共振成像(MRI)及磁共振血管成像(MRA)对小儿缺血性脑血管病的诊断价值。方法回顾性分析了42例小儿缺血性脑血管病患者,年龄1.2～14岁,平均7.5岁。全部病例均以急性起病的运动、语言障碍为主要症状来诊。采用轴位T1、T2加权像,部分病例加做冠状位或矢状位成像。其中31例进行了时间飞跃(TOF)法MR血管成像。结果本组共发现脑缺血8例,脑梗塞34例(其中腔隙梗塞22例,大面积梗塞12例)。单支颅内动脉狭窄6例,多支动脉狭窄4例;单支动脉闭塞3例,多支动脉闭塞2例;MOYAMOYA病9例(其中3例可见脑底异常血管网)。4例图像上有运动伪影,但能达到诊断要求。全部病例中,MRI表现典型、能单独确诊者36例,占85.7%。MRI与MRA相结合能确诊者40例,达95.2%。其余2例仅用MRI及MRA不能明确诊断,需结合临床资料及经随访证实。结论MRI结合MRA是小儿缺血性脑血管病的理想检查方法,可准确显示脑动脉的狭窄、闭塞性病变及其继发的脑缺血、梗塞病灶,对定性诊断具有重要价值。

Objective To demonstrate the diagnostic value of MR imaging and MR angiography in th e pediatric ischemic cere-brovascularl diseases.Methods Forty -two patients(aged 1.2to 14years,mean age 7.5years)with ischemic cerebrovascular diso rders presented with acute onset of dyskin esia or aphasia were retrospectively studied.Axial T 1 and T 2 weighted images were taken with spin echo or turbo spin echo sequences in all ca ses,coronal or sagittal images were supplied in some cases .Thirty -one c hildren umderwent MR angiography with time of flight tech ique in addition to MRI.Results Ischemic changes were identified in8cases and infarction were found in34cases(12massive infarction snd 22lacunar infarction cases)with MR imaging.MRA displayed single arterial stenosis in 6and multiple stenosis in 4cases,single arterial occclusion in 3and multiple arteria l occlusion in 2cases.Moyamoya dise ase were demonstrated in 9cases(basal cerebral moyamoya vessels were depicted in 3cases).The images of 4cases had motion artifact but avarilable for diagnosis.T hirty -six cases(85.7%)with typical findings can be correct ly diagnosed by MR imaging alone ,whereas 40cases(95.2%)can be correctly diagnosed by the integration of MR im aging and MR angiography.The other t wo cases can' t be diagnosed definitely by MRI and MRA,but can be confirmed by clinical data and follow -up MRI studies.Conclusion MR imaging combined with MR angiogra phy is a reliable method for the assessment of pediatric isch emic cerebrovascular disease.It ca n accurately depict the arterial ste nosis of occlusive disorders and its secondary cerebral ischemic changes or infarction.[