MRA与颈部血管彩超诊断颈动脉狭窄的比较
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摘要
目的:比较磁共振血管成像(MRA)与颈部血管彩色超声(简称"彩超")对脑梗死患者颈部血管检查的结果.方法:将290例核磁共振影像(MRI)或CT证实有脑梗死的患者,分别进行MRA、颈部血管彩超、数字减影血管造影(DSA)检查,并以DSA诊断结果为金标准,比较MRA、颈部血管彩超结果的差异性.结果:颈部血管彩超与MRA在腔隙性脑梗死组符合率差别不大(分别为97.18%,99.30%),而在中小面积脑梗死组及大面积脑梗死组符合率中两者可出现明显差异(分别为81.73%vs 91.35%;88.89%vs 92.86%),总体符合率MRA高于颈部血管彩超(分别为93.62%,87.07%).结论:MRA对脑梗死患者颈部血管检查准确率优于颈部血管彩超,当患者颈部血管病变越严重时两者差异越大,且两种检查方法均与DSA有一定的差距,应仔细斟酌两者的结果.
Aim: To compare the difference of cervical vascular examination in patients with cerebral infarction by MRA and neck vascular ultrasound. Methods: Two hundred and ninty cases of MRI or CT confirmed a lacunar cerebral infarction,MRA,neck vascular color Doppler ultrasound and DSA were performed separatively,and results of DSA in the diagnosis as the gold standard,we compared MRA,neck vascular color Doppler ultrasound results differences. Results: Neck vascular ultrasound and MRA in the lacunar infarction group's accord rate is not very different,and in small size cerebral infarction group and large area cerebral infarction group,the accord rate both can appear obvious differences,consistent with the overall rate of MRA was higher than that of neck vascular ultrasound. Conclusion:MRA in patients with cerebral infarction and neck vascular screening accuracy is better than that of neck vascular ultrasound,when vascular neck lesions in patients with more serious difference bigger and two kinds of inspection methods were with digital subtraction angiography(DSA) have a certain gap,should carefully consider the results of the two.
Aim: To compare the difference of cervical vascular examination in patients with cerebral infarction by MRA and neck vascular ultrasound. Methods: Two hundred and ninty cases of MRI or CT confirmed a lacunar cerebral infarction,MRA,neck vascular color Doppler ultrasound and DSA were performed separatively,and results of DSA in the diagnosis as the gold standard,we compared MRA,neck vascular color Doppler ultrasound results differences. Results: Neck vascular ultrasound and MRA in the lacunar infarction group's accord rate is not very different,and in small size cerebral infarction group and large area cerebral infarction group,the accord rate both can appear obvious differences,consistent with the overall rate of MRA was higher than that of neck vascular ultrasound. Conclusion:MRA in patients with cerebral infarction and neck vascular screening accuracy is better than that of neck vascular ultrasound,when vascular neck lesions in patients with more serious difference bigger and two kinds of inspection methods were with digital subtraction angiography(DSA) have a certain gap,should carefully consider the results of the two.
引文
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[16]顾苏兵,林高平,施天明,等.腔隙性脑梗死和脑血栓形成患者颅内动脉狭窄的分布及特点[J].中国动脉硬化杂志,2010,18(5):395-397.GU S B,LIN G P,SHI T M,et al.Distribution of Intracranial Artery Stenosis in Patients with Lacuna Infarct and Cerebral Thrombosis[J].Chinese Journal of Arteriosclerosis,2010,18(5):395-397
[17]BANG O Y,SAVER J L,BUCK B H,et al.Impact of collateral flow on tissue fate in acute ischaemic stroke[J].Journal of Neurology Neurosurgery&Psychiatry,2008,79(6):625-629.
[18]FIESCHI C,ARGENTINO C,LENZI G L,et al.Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours[J].Journal of the Neurological Sciences,1989,91(3):311-321.
[2]满育平,马隆佰,刘颖,等.非增强MRA和CTA在颈内动脉狭窄的临床诊断价值[J].放射学实践,2013,28(4):393-396.MAN Y P,Ma L B,LIU Y,et al.Value of nonenhanced MRA and CT angiography in the diagnosis of internal carotid artery stenosis[J].Radiologic Practice2013,28(4):393-396.
[3]INZITARI D,ELIASZIW M,SHARPE B L,et al.Risk factors and outcome of patients with carotid artery stenosis presenting with lacunar stroke.North American Symptomatic Carotid Endarterectomy Trial Group.[J].Neurology,2000,54(3):660-660.
[4]TEJADA J,DIEZTEJEDOR E,HERNANDEZECHEBARRIA L,et al.Does a relationship exist between carotid stenosis and lacunar infarction?[J].Stroke,2003,34(6):1404-1409.
[5]ROTHWELL P M,HOWARD S C,SPENCE J D.Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease.[J].Stroke,2003,34(11):2583-2590.
[6]WATERSTON J A,BROWN M M,BUTLER P,et al.Small deep cerebral infarcts associated with occlusive internal carotid artery disease.A hemodynamic phenomenon[J].Archives of Neurology,1990,47(9):953-957.
[7]YANG C W,CARR J C,FUTTERER S F,et al.Contrast-enhanced MR angiography of the carotid and vertebrobasilar circulations[J].Ajnr American Journal of Neuroradiology,2005,26(8):2095-2101.
[8]HEINSIUS T,BOGOUSSLAVSKY J,Van M G.Large infarcts in the middle cerebral artery territory.Etiology and outcome patterns[J].Neurology,1998,50(2):341-350.
[9]HARSCHER S,REICHART R,TERBORG C,et al.Outcome after decompressive craniectomy in patients with severe ischemic stroke[J].Acta Neurochirurgica,2006,148(1):31-37.
[10]董大伟,袁定新,王建民,等.动脉粥样硬化性脑梗死发病机制的特征及远期预后[J].暨南大学学报(自然科学与医学版),2013,34(6):640-645.DONG D W,YUAN D X,WANG J M,et al.Analysis of the underling mechanisms and long-term outcomes in patients with atherosclerotic cerebral infarction[J].Journal of Jinan University(Natural Science&Medicine Edition),2013,34(6):640-645.
[11]吴凤芸,张宇虹,苏本利,等.高频超声评价2型糖尿病患者颈动脉粥样硬化血管重构[J].中国医学影像技术,2009,25(1):65-68.WU F Y,ZHANG Y H,SU B L,et al.Study on remodeling of carotid atherosclerosis in patients of type 2diabetes mellitus with high-frequency ultrasound[J].Chinese Journal of Medical Imaging Technology,2009,25(1):65-68.
[12]RAGAB Y,EMAD Y,EL-MARAKBI A,et al.Clinical utility of magnetic resonance angiography(MRA)in the diagnosis and treatment of Takayasu's arteritis[J].Clinical Rheumatology,2007,26(8):1393-1395.
[13]DEBREY S M,YU H,LYNCH J K,et al.Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease:a systematic review and metaanalysis[J].Stroke,2008,39(8):2237-2248.
[14]HIRAI T,KOROGI Y,ONO K,et al.Prospective evaluation of suspected stenoocclusive disease of the intracranial artery:combined MR angiography and CT angiography compared with digital subtraction angiography[J].Ajnr American Journal of Neuroradiology,2002,23(1):93-101.
[15]姜国锋,战祥波,殷浩,等.3.0T MR头颈部3DTOF-MRA的临床应用[J].中国实验诊断学,2013,17(5):894-895.JIANG G F,ZHAN X B,YIN H,et al.3.0 T MR clinical application of 3D-TOF-MRA on head and neck[J].Chinese Journal of Laboratory Diagnosis,2013,17(5):894-895.
[16]WUTKE R,LANG W,FELLNER C,et al.Highresolution,contrast-enhanced magnetic resonance angiography with elliptical centric k-space ordering of supra-aortic arteries compared with selective X-ray angiography[J].Stroke,2002,33(6):1522-1529.
[16]顾苏兵,林高平,施天明,等.腔隙性脑梗死和脑血栓形成患者颅内动脉狭窄的分布及特点[J].中国动脉硬化杂志,2010,18(5):395-397.GU S B,LIN G P,SHI T M,et al.Distribution of Intracranial Artery Stenosis in Patients with Lacuna Infarct and Cerebral Thrombosis[J].Chinese Journal of Arteriosclerosis,2010,18(5):395-397
[17]BANG O Y,SAVER J L,BUCK B H,et al.Impact of collateral flow on tissue fate in acute ischaemic stroke[J].Journal of Neurology Neurosurgery&Psychiatry,2008,79(6):625-629.
[18]FIESCHI C,ARGENTINO C,LENZI G L,et al.Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours[J].Journal of the Neurological Sciences,1989,91(3):311-321.