后循环缺血导致的孤立性眩晕MRI应用进展
摘要
眩晕是神经内科门诊最常见的主诉,椎基底动脉缺血可导致小脑、脑干梗死,早期可仅表现为孤立性眩晕,临床确诊比较困难。从孤立性眩晕患者中筛查出血管源性卒中患者非常关键。以往常规MRI结合MRA对后循环缺血性病变的检出敏感度较高,但特异度一般。动脉自旋标记(ASL)成像技术较MRA能更直观地反映后循环的血流变化并且能对其定量分析,采用ASL技术结合常规MRI、DWI和MRA对责任血管、缺血部位及缺血严重程度进行判断,可显著提高磁共振检查对于早期脑缺血性眩晕的检出率及准确性。
引文
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[2]胡联国,孙敬武.340例眩晕患者的病因分析[J].中华耳科学杂志,2015,13(4):700-703.
[3] Seemungal BM.Neuro-otological emergencies[J].Curr Opin Neurol,2007,20(1):32-39.
[4]何育生,李云霞,韩红杰,等.孤立性眩晕型小脑梗死的临床与影像学特征[J].中风与神经疾病杂志,2013,30(12):1074-1076.
[5] Tarnutzer,Alexander A,Berkowitz,et al.Does my dizzy patient have a stroke:A systematic review of bedside diagnosis in acute vestibular syndrome[J].CMAJ,2011,183(9):571-592.
[6] Lee H.Isolated vascular vertigo[J].J Stroke,2014,16(3):124-130.
[7]赵丹丹,毕国荣.后循环缺血性孤立性眩晕[J].中国神经精神疾病杂志,2015,41(9):575-577.
[8] Caplan L.Posterior circulation ischemia:then,now,and tomorrow:the thomas Willis lecture 2000[J].Stroke,2000,31(8):2011-2023.
[9] Gulli G,Marquardt L,Rothwell PM,et al.Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis:pooled data analysis from prospective studies[J].Stroke,2013,44(3):598-604.
[10]Mosarrezai A,Toghae M,Majed M,et al.Isolated vertigo and possibility of brain ischemia[J].Arch Iran Med,2012,15(8):469-471.
[11]毛晓薇,毕晓莹.神经内科171例孤立性眩晕患者病因分析[J].中国卒中杂志,2016,11(5):373-377.
[12] Chalela JA,Kidwell CS,Nentwich LM,et al.Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke:aprospective comparison[J].Lancet,2007,369(9558):293-298.
[13]曹笃,牟君,魏有东,等.脑卒中早期磁共振弥散加权成像阴性1例[J].第三军医大学学报,2013,35(11):1128.
[14]路虹,王团,张燕卓,等.CT、MRI和磁共振动脉成像对后循环缺血性眩晕的诊断价值[J].中国耳鼻咽喉头颈外科,2011,18(11):581-584.
[15] Dubey TN,Nahar N,Thomas A.Study of magnetic resonance angiography in cases of central vertigo and its clinical correlation[J].J Neurol Sci,2015,357(Sup 1):S172.
[16] Akoglu EU,Akoglu H,Cimilli Ozturk T,et al.Predictors of false negative diffusion-weighted MRI in clinically suspected central cause of vertigo[J].Am J Emerg Med,2018,36(4):615-619.
[17]闫蕾,王效春,张辉,等.动脉自旋标记技术的原理及其在缺血性脑卒中诊断中的应用[J].中西医结合心脑血管病杂志,2016,14(2):213-214.
[18]Mutke MA,Madai VI,von Samson-Himmelstjerna FC,et al.Clinical evaluation of an arterial-spin-labeling product sequence in steno-occlusive disease of the brain[J/OL].PLoS One,2014,9(2):e87143.DOI:10.1371/journal.pone.0087143.eCollection2014.
[19] van Laar PJ,van der Grond J,Hendrikse J.Brain perfusion territory imaging:methods and clinical applications of selective arterial spin-labeling MR imaging[J].Radiology,2008,246(2):354-364.
[20] Zaharchuk G,El Mogy IS,Fischbein NJ,et al.Comparison of arterial spin labeling and bolus perfusion-weighted imaging for detecting mismatch in acute stroke[J].Stroke,2012,43(7):1843-1848.
[21] Huang YC,Liu HL,Lee JD,et al.Comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MRI in patients with acute stroke[J/OL].PLoS One,2013,8(7):e69085.DOI:10.1371/journal.pone.0069085.Print 2013.
[22]罗海龙,黄力.动脉自旋标记的新进展及其在缺血性脑血管病的应用[J].国际医学放射学杂志,2014,37(1):58-62.
[23]张顺,张水霞,姚义好,等.三维动脉自旋标记在缺血性脑血管病中的应用研究[J].放射学实践,2015,30(2):119-123.
[24]王树春,辛毅,马智军,等.3D-ASL联合MRA诊断DWI阴性TIA[J].中国医学计算机成像杂志,2016,22(1):5-8.
[25]贾芮,徐贤,刘新球,等.三维准连续动脉自旋标记灌注成像对老年人后循环缺血病灶的诊断价值[J].中国医学科学院学报,2017,39(2):272-279.
[26] Lin T,Lai Z,Lv Y,et al.Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy[J].Eur Radiol,2018,28(2):727-735.
[27]赵光明,唐纳,张洁,等.3DASL脑灌注成像:不同标记后延迟时间对血流测量的影响[J].放射学实践,2016,31(12):1168-1171.