磁共振成像对血管性眩晕的诊断价值
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摘要
目的:运用3.0T磁共振检查寻找血管性眩晕患者明确的发病原因,探讨血管性眩晕的MRI检查方法及诊断价值,从而指导临床进行有针对性的治疗。
方法:选取并分析寻找到明确病因的99例患者的影像学资料。入选标准:①有眩晕发作的临床表现,入选者以眩晕为主诉,表现为头昏目眩,视物旋转,可伴有恶心呕吐,眼球震颤,耳鸣耳聋,共济失调等。②同时寻找到确切的前庭系统血液灌注不足的证据,MR可表现为椎基底动脉不同程度的硬化,后循环供血区脑梗死等。③除外梅尼埃病、位置性眩晕、迷路炎、耳硬化、外伤性眩晕、肿瘤等其他导致眩晕的疾病。99例行患者均行颅脑MRI及MRA检查,其中3例患者进行特殊序列三维稳态进动快速成像序列(3D fast imaging employing steady-state acquisition , 3D-FIESTA)检查,32例眩晕患者前期行CT检查。采用GE公司Signa Excite 3.0T超导磁共振成像设备,扫描序列包括横断面T1-FLAIR和T2-FLAIR、横断面和矢状面T2-FSE。MRA采用3D-TOF法。MRA图像观察以最大密度投影( maximum intensity projection, MIP )重组后图像为主,辅以MRA源图像。3D-FIESTA序列为-垂直于内听道的双耳斜矢状位及横断面三维稳态进动快速成像序列检查。CT检查采用GE Light Speed 4层或16层螺旋CT扫描仪。结合患者详细的发病史、临床表现和体征,参考所有已知可能造成血管性眩晕的病因,对所获得MRI及CT图像的阳性征象进行多次综合分析。两位经验丰富的影像学医师以盲法观察颅脑MRI、MRA及CT图像,将脑实质MRI表现、椎-基底动脉病变、小脑前下动脉的病变、小脑后下动脉的病变进行分型,根据年龄段划分引起血管性眩晕的常见病因构成,比较MRI与CT对脑实质的检查结果的差异,并对部分患者行3D-FIESTA检查,明确迷路动脉的血供与前庭蜗神经的关系,力争达到临床表现与影像学表现的统一解释,通过观察眩晕患者的脑实质及相关血管的形态学变化,探讨磁共振成像检查在血管性眩晕疾病的诊断价值,并提高眩晕疾病的确诊率,为今后的临床的诊断和治疗提供参考。应用SPSS13.0统计学软件对所有数据进行分析,计数资料采用χ2检验,以P<0.05作为差异有统计学意义。
结果:99例行MRI及MRA检查的患者中脑实质存在病变者50例,其中单纯小脑梗死者22例,单纯脑干梗死者3例,小脑合并脑干梗死者10例,单纯脑干受压者14例,后循环血管瘤1例并压迫脑干。不同性别之间脑干有无受压不存在差异(χ2=0.499,P=0.480)。椎-基底动脉的MRA形态异常表现:左、右椎动脉病变类型不存在统计学差异(χ2=1.080 P=0.998),A型共63条, B型共33条,C型共35条,D型共12条,A型+B型共8条,B型+C型共8条,A型+B型+C型2条,无异常者10。基底动脉:A型59条,B型10条,C型11条,A型+B型6条,无异常者13条。而各个年龄段引起血管性眩晕的疾病存在差异(χ2=19.943,P=0.030),50岁以上血管性眩晕患者占78%。小脑前下动脉MRA表现三个年龄段当中不存在统计学差异(χ2=5.516,P=0.238),左、右侧小脑前下动脉在MRA表现上无显著性差异(χ2=0.269,P=0.862)。小脑后下动脉MRA表现三个年龄段当中不存在统计学差异(χ2=4.132,P=0.388),左、右侧小脑后下动脉在MRA表现上无显著性差异(χ2=0.153,P=0.926)。13例26侧行3D-FIESTA序列检查的病人当中,血液循环障碍3侧,考虑微血管压迫前庭蜗神经或/且与之粘连1侧。32例行MRI、MRA及CT检查的患者当中,CT表现为阳性的为9例,阴性的为23例;MRI表现为阳性的为24例,阴性的为8例。CT与MRI检查结果存在显著的差异(χ2=14.076,P=0.000)。11例脑梗的眩晕患者发病24小时内行CT以及MRI检查,CT与MRI检查结果之间存在显著的差异(χ2=12.034,P=0.001)
结论:MRI能早期并准确的表现脑梗塞,甚至早期的缺血改变,较CT有明显的优势。MRA从宏观上判断后循环的的动脉粥样硬化的有无及严重程度以及验证血管对脑干的压迫,这是MRI检查所不能替代的。3D-FIESTA从微观上显示迷路动脉的血供情况,显示压迫特别是血管对前庭蜗神经的压迫。血管性眩晕是临床上的常见病、多发病,病变类型具有多样性,在血管性眩晕当中后循环缺血(VBTIV、AICA综合征、Wallenberg综合征、桥臂综合征)是引起血管性眩晕的主要病因,而脑干受血管因素压迫、前庭耳蜗神经血管压迫症、迷路动脉综合征也属于血管性眩晕范畴。3.0T MRI和MRA扫描能提供详细的解剖学信息,为对血管性眩晕病变病因的认识、诊断和行针对性治疗提供重要的依据。3D-FIESTA序列扫描就能够准确的显示血管与神经的关系,对前庭耳蜗神经血管压迫症、迷路动脉综合征的诊断颇有价值。综合利用MRI平扫、MRA及3D-FIESTA-C序列,能全面、详细、准确的探求血管性眩晕患者的病因,而且为血管性眩晕的影像学研究指明了方向。
Objective: To finding the etiologic factors and obtaining a fairly definite imaging diagnosis conclusion possibly of vascular vertigo by 3.0 T MRI, and directing the clinical treatment for a certain purpose.
Methods: Study the 99 patients’imageology data that were diagnosed as vascular vertigo. The standard to be selected:①the vertigo is first clinical situation; may accompanies nausea and vomiting, tinnitus, deafness, nystagmus, dysarthria, right sided facial weakness, dysesthesia, gait disturbance and so on.②Magnetic Resonance shows the vertebral-basilar artery artherosclerosis and posterior circulation ischemic (PCI).③We exclude the meniere disease, labyrinthitis, positional vertigo, otosclerosis, tumor, injury vertigo and so on when we study the cases. All the patients were examined by MRI and MRA. 13 patients were examined by 3D fast imaging employing steady-state acquisition. 32 patients were examined by CT before the inspection of MRI and MRA. The MRI and MRA images were observed by Signa Excite HD 3.0T high field MR scanner. Magnetic Resonance Angiography (MRA) was performed by using a 3D-TOF sequence. With MIP reorganized images assisted by source images. 3D-FIESTA is a special sequence in transverse plane and oblique anteroposterior plane, and 3D reconstruction for some special patients. We adopt GE Light Speed 4 layer or 16layer MSCT scanner. To integrate the case history, clinical situation, physical sign, reference cause of a disease, aggregate analysis the result of MRI,MRA and CT. Images were reviewed concurrently by two skilled radiologists with double blind test. TO grouping the appearance of the brain, the course of vertebro-basilar artery, the relationship of the age and cause of the disease, the abnormity of anterior inferior cerebellar arteryz(AICA) and posterior inferior cerebellar artery(PICA) were observed and recorded. To compare the difference of results of MRI and CT. We strive to achieve a uniform interpretation for clinical situation and imageology appearance. We explore the diagnostic criteria of vascular vertigo by observing the Magnetic Resonance appearance on the brain essence and vascular. Statistical testing was performed by usingχ2 contingency tables and there was significant difference when P<0.05.
Results:In the 99 patients, cerebral infarction was 22 cases, brain stem infarction was 3 cases, cerebral and brain stem infarction was 10 cases, brain stem compression was 14 cases,posterior circulation angioma and compress the brain stem 1case.When it comes to brain stem compression, there was no difference between the different sex(χ2=0.499,P=0.480). There was no difference between the right and left vertebral artery about the pathological changes type(χ2=1.080, P=0.998). The difference cause of vascular vertigo consist in different age group case(χ2=19.943,P=0.030). Over the age of 50 in patients with vascular vertigo was 81%. The MRA shows the AICA of the three age group consist in no difference(χ2=5.516,P=0.238), but the AICA of right and left was no difference(χ2=0.296,P=0.862). The MRA shows the PICA of the three age group was no difference(χ2=4.132,P=0.388), but the PICA of right and left was no difference(χ2=0.153,P=0.926). In the 3 cases 6 ears examined by 3D-FIESTA, dysaemias 3 cases. Labyrinthine artery oppressing and/or adhereing vestibulococholear nerve 1 case. There was significant difference between the results of CT and MRI(χ2=14.076,P=0.000). 11 cases with cerebral infarction were made the CT and MRI inspection in the 24 hours and the results of CT and MRI consists significant difference(χ2=12.034,P=0.001).
Conclusions: MRI to show the cerebral infarction earlier than CT. MRA to show the blood vessel atherosclerotic macroscopic, to prove the brainstem Compression. 3D-FIESTA shows blood vessel microcosmic, it shows the labyrinthine artery and Vestibular cochlear nerve vascular compression limpidly. Vascular vertigo is common disease, and to have multiformity. Posterior circulation ischemic (PCI) is the main cause of vascular vertigo. brain stem compression, vestibular cochlear nerve vascular compression syndrome,labyrinthine artery syndrome should belong to the vascular vertigo. 3.0T MRI and MRA could provide detailed anatomy information, to provide a basis for diagnosis and treatment of vascular vertigo. 3D-FIESTA-C scanning could to show the relationship of blood vessel and nerve. Comprehensive use of MRI scan, MRA, and 3D-FIESTA sequence, could hunt the cause of vascular vertigo perfectly. This study indicates a way for the study of vascular vertigo.
方法:选取并分析寻找到明确病因的99例患者的影像学资料。入选标准:①有眩晕发作的临床表现,入选者以眩晕为主诉,表现为头昏目眩,视物旋转,可伴有恶心呕吐,眼球震颤,耳鸣耳聋,共济失调等。②同时寻找到确切的前庭系统血液灌注不足的证据,MR可表现为椎基底动脉不同程度的硬化,后循环供血区脑梗死等。③除外梅尼埃病、位置性眩晕、迷路炎、耳硬化、外伤性眩晕、肿瘤等其他导致眩晕的疾病。99例行患者均行颅脑MRI及MRA检查,其中3例患者进行特殊序列三维稳态进动快速成像序列(3D fast imaging employing steady-state acquisition , 3D-FIESTA)检查,32例眩晕患者前期行CT检查。采用GE公司Signa Excite 3.0T超导磁共振成像设备,扫描序列包括横断面T1-FLAIR和T2-FLAIR、横断面和矢状面T2-FSE。MRA采用3D-TOF法。MRA图像观察以最大密度投影( maximum intensity projection, MIP )重组后图像为主,辅以MRA源图像。3D-FIESTA序列为-垂直于内听道的双耳斜矢状位及横断面三维稳态进动快速成像序列检查。CT检查采用GE Light Speed 4层或16层螺旋CT扫描仪。结合患者详细的发病史、临床表现和体征,参考所有已知可能造成血管性眩晕的病因,对所获得MRI及CT图像的阳性征象进行多次综合分析。两位经验丰富的影像学医师以盲法观察颅脑MRI、MRA及CT图像,将脑实质MRI表现、椎-基底动脉病变、小脑前下动脉的病变、小脑后下动脉的病变进行分型,根据年龄段划分引起血管性眩晕的常见病因构成,比较MRI与CT对脑实质的检查结果的差异,并对部分患者行3D-FIESTA检查,明确迷路动脉的血供与前庭蜗神经的关系,力争达到临床表现与影像学表现的统一解释,通过观察眩晕患者的脑实质及相关血管的形态学变化,探讨磁共振成像检查在血管性眩晕疾病的诊断价值,并提高眩晕疾病的确诊率,为今后的临床的诊断和治疗提供参考。应用SPSS13.0统计学软件对所有数据进行分析,计数资料采用χ2检验,以P<0.05作为差异有统计学意义。
结果:99例行MRI及MRA检查的患者中脑实质存在病变者50例,其中单纯小脑梗死者22例,单纯脑干梗死者3例,小脑合并脑干梗死者10例,单纯脑干受压者14例,后循环血管瘤1例并压迫脑干。不同性别之间脑干有无受压不存在差异(χ2=0.499,P=0.480)。椎-基底动脉的MRA形态异常表现:左、右椎动脉病变类型不存在统计学差异(χ2=1.080 P=0.998),A型共63条, B型共33条,C型共35条,D型共12条,A型+B型共8条,B型+C型共8条,A型+B型+C型2条,无异常者10。基底动脉:A型59条,B型10条,C型11条,A型+B型6条,无异常者13条。而各个年龄段引起血管性眩晕的疾病存在差异(χ2=19.943,P=0.030),50岁以上血管性眩晕患者占78%。小脑前下动脉MRA表现三个年龄段当中不存在统计学差异(χ2=5.516,P=0.238),左、右侧小脑前下动脉在MRA表现上无显著性差异(χ2=0.269,P=0.862)。小脑后下动脉MRA表现三个年龄段当中不存在统计学差异(χ2=4.132,P=0.388),左、右侧小脑后下动脉在MRA表现上无显著性差异(χ2=0.153,P=0.926)。13例26侧行3D-FIESTA序列检查的病人当中,血液循环障碍3侧,考虑微血管压迫前庭蜗神经或/且与之粘连1侧。32例行MRI、MRA及CT检查的患者当中,CT表现为阳性的为9例,阴性的为23例;MRI表现为阳性的为24例,阴性的为8例。CT与MRI检查结果存在显著的差异(χ2=14.076,P=0.000)。11例脑梗的眩晕患者发病24小时内行CT以及MRI检查,CT与MRI检查结果之间存在显著的差异(χ2=12.034,P=0.001)
结论:MRI能早期并准确的表现脑梗塞,甚至早期的缺血改变,较CT有明显的优势。MRA从宏观上判断后循环的的动脉粥样硬化的有无及严重程度以及验证血管对脑干的压迫,这是MRI检查所不能替代的。3D-FIESTA从微观上显示迷路动脉的血供情况,显示压迫特别是血管对前庭蜗神经的压迫。血管性眩晕是临床上的常见病、多发病,病变类型具有多样性,在血管性眩晕当中后循环缺血(VBTIV、AICA综合征、Wallenberg综合征、桥臂综合征)是引起血管性眩晕的主要病因,而脑干受血管因素压迫、前庭耳蜗神经血管压迫症、迷路动脉综合征也属于血管性眩晕范畴。3.0T MRI和MRA扫描能提供详细的解剖学信息,为对血管性眩晕病变病因的认识、诊断和行针对性治疗提供重要的依据。3D-FIESTA序列扫描就能够准确的显示血管与神经的关系,对前庭耳蜗神经血管压迫症、迷路动脉综合征的诊断颇有价值。综合利用MRI平扫、MRA及3D-FIESTA-C序列,能全面、详细、准确的探求血管性眩晕患者的病因,而且为血管性眩晕的影像学研究指明了方向。
Objective: To finding the etiologic factors and obtaining a fairly definite imaging diagnosis conclusion possibly of vascular vertigo by 3.0 T MRI, and directing the clinical treatment for a certain purpose.
Methods: Study the 99 patients’imageology data that were diagnosed as vascular vertigo. The standard to be selected:①the vertigo is first clinical situation; may accompanies nausea and vomiting, tinnitus, deafness, nystagmus, dysarthria, right sided facial weakness, dysesthesia, gait disturbance and so on.②Magnetic Resonance shows the vertebral-basilar artery artherosclerosis and posterior circulation ischemic (PCI).③We exclude the meniere disease, labyrinthitis, positional vertigo, otosclerosis, tumor, injury vertigo and so on when we study the cases. All the patients were examined by MRI and MRA. 13 patients were examined by 3D fast imaging employing steady-state acquisition. 32 patients were examined by CT before the inspection of MRI and MRA. The MRI and MRA images were observed by Signa Excite HD 3.0T high field MR scanner. Magnetic Resonance Angiography (MRA) was performed by using a 3D-TOF sequence. With MIP reorganized images assisted by source images. 3D-FIESTA is a special sequence in transverse plane and oblique anteroposterior plane, and 3D reconstruction for some special patients. We adopt GE Light Speed 4 layer or 16layer MSCT scanner. To integrate the case history, clinical situation, physical sign, reference cause of a disease, aggregate analysis the result of MRI,MRA and CT. Images were reviewed concurrently by two skilled radiologists with double blind test. TO grouping the appearance of the brain, the course of vertebro-basilar artery, the relationship of the age and cause of the disease, the abnormity of anterior inferior cerebellar arteryz(AICA) and posterior inferior cerebellar artery(PICA) were observed and recorded. To compare the difference of results of MRI and CT. We strive to achieve a uniform interpretation for clinical situation and imageology appearance. We explore the diagnostic criteria of vascular vertigo by observing the Magnetic Resonance appearance on the brain essence and vascular. Statistical testing was performed by usingχ2 contingency tables and there was significant difference when P<0.05.
Results:In the 99 patients, cerebral infarction was 22 cases, brain stem infarction was 3 cases, cerebral and brain stem infarction was 10 cases, brain stem compression was 14 cases,posterior circulation angioma and compress the brain stem 1case.When it comes to brain stem compression, there was no difference between the different sex(χ2=0.499,P=0.480). There was no difference between the right and left vertebral artery about the pathological changes type(χ2=1.080, P=0.998). The difference cause of vascular vertigo consist in different age group case(χ2=19.943,P=0.030). Over the age of 50 in patients with vascular vertigo was 81%. The MRA shows the AICA of the three age group consist in no difference(χ2=5.516,P=0.238), but the AICA of right and left was no difference(χ2=0.296,P=0.862). The MRA shows the PICA of the three age group was no difference(χ2=4.132,P=0.388), but the PICA of right and left was no difference(χ2=0.153,P=0.926). In the 3 cases 6 ears examined by 3D-FIESTA, dysaemias 3 cases. Labyrinthine artery oppressing and/or adhereing vestibulococholear nerve 1 case. There was significant difference between the results of CT and MRI(χ2=14.076,P=0.000). 11 cases with cerebral infarction were made the CT and MRI inspection in the 24 hours and the results of CT and MRI consists significant difference(χ2=12.034,P=0.001).
Conclusions: MRI to show the cerebral infarction earlier than CT. MRA to show the blood vessel atherosclerotic macroscopic, to prove the brainstem Compression. 3D-FIESTA shows blood vessel microcosmic, it shows the labyrinthine artery and Vestibular cochlear nerve vascular compression limpidly. Vascular vertigo is common disease, and to have multiformity. Posterior circulation ischemic (PCI) is the main cause of vascular vertigo. brain stem compression, vestibular cochlear nerve vascular compression syndrome,labyrinthine artery syndrome should belong to the vascular vertigo. 3.0T MRI and MRA could provide detailed anatomy information, to provide a basis for diagnosis and treatment of vascular vertigo. 3D-FIESTA-C scanning could to show the relationship of blood vessel and nerve. Comprehensive use of MRI scan, MRA, and 3D-FIESTA sequence, could hunt the cause of vascular vertigo perfectly. This study indicates a way for the study of vascular vertigo.
引文
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16黄选兆主编.耳鼻咽喉科学.第3版.北京:人民卫生出版社,1990.228
17 Kim JS, Lopez I, DiPatre PL, et al. Internal auditory artery infarction: clinicopathologic correlation [J]. Neurology, 1999,52 :40
18李敬武,刘怀军,李晖,等.椎一基底动脉病变类型:3.0T MR与MRA观察.中国医学影像技术,2008,24(11):1718-1720
19 Schulz R,Fegbeutel C,Althoff A,et a1.Central sleep apnoea and unilateral diaphragmatic paralysis associated with vertebral artery co- mpression of the medulla oblongata [J].J Neural,2003,250 (4): 503-505
20宋利宏,刘怀军,李晖,等.基底动脉过长弯曲的3.0TMRI研究[J].山东医药,2009,45(9):71-72
21庄晓荣,童绥君,林晓芳.小脑前下动脉梗死的临床特征及病因探讨[J].中风与神经疾病杂志,2003,20(11):422—423
22 Tohgi H, Takahashi S, Chiba K, et a1.Cerebellar infarction.Clinical and neuroimaging analysis in 293 patients.The Tohoku Cerebellar Infarction Study Group [J].Stroke, 1993,24(I1):l697一l7O1
23 Isao Kato, Sadao Ogino , Tomoyuki Okada, et al. Wallenberg’s syndrome: neurotological classification. Auris, Nasus, Larynx,2003,30:13-18
24 Wilkins R, Brody I. Wallenberg’s syndrome. Arch Neurol, 1970, 22:613
25曾司鲁,高摄渊,李旭光,等.脑血管解剖学[M].北京科学出版社,1983:83—85
26张英华,高国栋,刘怀军,等.CT和多种MRI成像方法在突发性耳聋中的选择和应用[J].河北医药,2009,31(16):2124-2126
27 Passero S, Rossi S, Giannini F, et al. Brain2stem comp ression in vertebr obasilar dolichoectasia . A multi modal electrophysiological study . Clin Neurophysiol , 2001,112: 1531
28 Bruzzone MG , Grisoli M, De Simone T, et al. Neuroradiological features of vertigo [J]. Neurol Sci, 2004, 25:S20–S23
29 Dumas G, Schmerber S, Boulat E, et al. Cavernous angiomas of the brainstem: auditory and vestibula manifestations. Rev Laryngol Otol Rhinol.2001; 122:103-110
30乔胜铎,邱建华,苏钰,等.小脑下前动脉与前庭蜗神经关系的解剖学观察.解剖学报2005,36(2):210-211
31徐宏兵,齐滕贵德,黄公怡,等.受压迫神经内血流量变化的研究[J].中华骨科杂志,2000,20(10):298-600
32 Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology. Laryngoscope, 1992, 102: 1030-1036
33 Ryu H, Yamamoto S, Sugiyama K, et al. Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptom? Acta Neurochir.1999;141:495-501
34龚万庆,陶晓峰,高欣,等.MRI高分辨率3D序列检测血管性神经压迫[J].华南国防医学杂志,2009,23(3):28—30
35 Casselman JW. Diagnostic imaging in clinical neuro-otology. Current Opinion in Neurology, 2002, 15:23–30
36 McCarthy R M, Shea S M, Deshpande VS, et al. Coronary MR angiography: true FISP imaging improved by prolonging breath holds with preoxygenation in healthy volunteers. Radiology, 2003, 227:283
1乔胜铎,邱建华,苏钰,等.小脑下前动脉与前庭蜗神经关系的解剖学观察[J].解剖学报,2005,36(2):210-211
2 Cosar M, Yaman M, Eser O, et al. Basilar artery angulation and vertigo due to the hemodynamic effect of dominant vertebral artery[J]. Medical Hypotheses,2008,70:941–943
3赵义. 115例前庭系统性眩晕患者脑干听觉诱发电位分析[J].中国实用神经疾病杂志,2006,9(2):57-58
4吕凡,黄魏宁.血管性眩晕[J].国外医学耳鼻咽喉科学分册2004,28(4):209-213
5苗顺来,佟树文,裴香莲,等.小脑下前动脉综合征[J].中国临床耳鼻咽喉头颈外科,2007,21(10):476
6徐宏兵,齐滕贵德,黄公怡,等.受压迫神经内血流量变化的研究[J].中华骨科杂志2000,20(10):298-600
7 Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology. Laryngoscope,1992,102: 1030-1036
8石晓花,冯雪玲,沈琼霞,等.脑干听觉诱发电位在老年人椎基底动脉供血不足的诊断价值[J].中风与神经疾病杂志,2009,26(2):228-230
9魏梦绮,宦怡,葛雅丽,等.DWI及FLAIR技术在急性脑梗塞中的临床应用探讨[J].实用放射学杂志,2003,19(3):204-207
10徐冉.磁共振对脑梗死责任病灶的显示情况分析[J].实用医技杂志,2008,15(1):4-5
11 Fujita N, Yamanaka T, Hosoi H, et al. Usefulness of MR angiography in cases of central vertigo[J]. Auris, Nasus, Larynx,2002,29:247-252
12黄胜,龚沈初,姜洪标.3D TOF MRA与3D CE MRA对脑血管病的诊断价值[J].南京医科大学学报,2006,26(12):1257-1260
13张英华,高国栋,刘怀军,等. 3D-FIESTA-C序列在突发性耳聋诊断中的应用[J].河北医药,2009,31(17):2261-2262
14 Nail Bulakba??, Yüksel Pabu??u. Neuro-otologic applications of MRI[J]. Neuroradilogy. 2007,13:109–120
15张迪,路虹.磁共振成像在耳科疾病诊治中的应用[J].中华耳鼻咽喉头颈外科杂志,2005,40(2):156-158
16 Yamasoba T, Kikuchi S, Higo R. Deafness associated with vertebrobasilar insufficiency[J]. Neurological Sciences,2001,187:69–75
17李自如,郭力军.椎-基底动脉供血不足性眩晕的MRA改变及临床分析[J].中国老年学杂志,2007,27:2416-2417
18 Choi KD, Chun JU, Han MG, et al. Embolic internal auditory artery infarction from vertebral artery dissection[J]. J Neuro Sci. 2006,246: 169–172
19 Lee H, Ahn BH, Baloh RW, et al. Sudden deafness with vertigo as a sole manifestation of anterior inferior cerebellar artery infarction[J]. J Neurol Sci,2004,222:105–107
20 Tohgi H,Takahashi S, Chiba K,et al.Cerebellar infarction: Clinical and neuroimaging analysis in 293 patients[J].Strote,1993,24:1679-1701.
21 Bruzzone MG, Grisoli M, De Simone T, et al. Neuroradiological features of vertigo[J]. Neurol Sci, 2004, 25:S20–S23
22张英华,高国栋,刘怀军,等.CT和多种MRI成像方法在突发性耳聋中的选择和应用[J].河北医药,2009,31(16):2124-2126
23 Passero S, Rossi S, Giannini F, et al. Brain2stem comp ression in vertebr obasilar dolichoectasia . A multi modal electrophysiological study . ClinNeurophysiol , 2001,112: 1531
24李晖,刘怀军,杨桦,等.椎-基底动脉病变引起脑干形态及位置变化的3.0TMRI研究[J].临床放射学杂志,2008,27(9):1171-1175
25 Dumas G, Schmerber S, Boulat E, et al. Cavernous angiomas of the brain stem: auditory and vestibular manifestations. Rev Laryngol Otol Rhinol,2001,122:103-110
26 Weissman JL, Hirsch BE. Imaging of tinnitus: a review [J] .Radiology, 2000, 216:342-349
27王冰,王振常,鲜军舫,等.正常人内听道段神经、血管MRI表现[J].中国医学影像技术,2007,23(4):503-506
28 Ryu H, Tanaka T, Yamamoto S, et al. Magnetic resonance cisternography used to determine precise topography of t he facial nerveand t hree component s of t he eight h cranial nerve in the internal auditory canal and cerebellopontine cistern[J]. J Neurosurg,1999,90(4) :624-634
29 Ryu H,Yamamoto S,Sugiyama K,et al,Neurovascular decompression of the eighth cranial nerve in Patients with hemifacial spasm and incidental tinnitus:an alternative way to study tinnitus[J]. J Neurosurg. 1998,88(2):232一236
30 Krombach GA, Schmitz-Rode T, Tacke J, et al. MRI of the inner earcomparison of axial T2-weighted, a three dimensional turbo spinechoimages,maximum intensity projections, and volume rendering[J]. Invest Radiol, 2000, 35:337-342
30 Sirikci A,Bayazit Y,Ozer E,et al. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms [J]. Surg Radiol Anat,2005, 27(6):531-535
31 Okumura Y , Suzuki M , Takemura A,et al . Visualization of the lower cranial nerves by 3D-FIESTA [J]. Nippon Hoshasen Gijutsu Gakkai Zasshi,2005,61(2):291-297
32 Gultekin S, Celik H, Akpek S,et al. Vascular loops at the cerebellopontine angle: is there a correlation with tinnitus? J Neuroradiol, 2008,29(9):1746-1749
33 Sertac Yetiser, Mustafa Kertmen, Altan Yildirim.An analysis of correlation between the unusual location of thejugular bulb and audiovestibular symptoms。Auris Nasus Larynx, 2004,31:369–377.
34 Casselman JW. Diagnostic imaging in clinical neuro-otology. Current Opinion in Neurology, 2002, 15:23–30
35韩博,杨广夫,何滨,等.颈静脉球MRV成像研究[J].中国临床医学影像杂志,2008,19(11):809-811
2黄选兆主编.适用耳鼻咽喉头颈外科学,第二版.人民卫生出版社,2008:1042
3 Norrving B;Magnusson M;Holtas S;Isolated acute vertigo in the elderly; vestibular or vascular disease? Acta Neurol Scand. 1995,911:43-48
4 Fujita N, Yamanaka T, Hosoi H, et al. Usefulness of MR angiography in cases of central vertigo[J]. Auris, Nasus, Larynx,2002,29:247-252
5 Rother J, Wentz KU, Rautenberg W, et al. Magnetic resonance angiography in vertebrobasolar ischemia, Stroke, 1993, 24(9):1310
6乔胜铎,邱建华,苏钰,等.小脑下前动脉与前庭蜗神经关系的解剖学观察[J].解剖学报,2005,36(2):210-211
7 Cosar M, Yaman M, Eser O, et al. Basilar artery angulation and vertigo due to the hemodynamic effect of dominant vertebral artery[J]. Medical Hypotheses,2008,70:941–943
8赵义.115例前庭系统性眩晕患者脑干听觉诱发电位分析[J].中国实用神经疾病杂志,2006,9(2):57-58
9 Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology. Laryngoscope,1992,102: 1030-1036
10中国后循环缺血专家共识组.中国后循环缺血的专家共识[J].中华内科杂志,2006,45:786
11吴子明,张素珍,杨伟炎,等.后循环缺血概念的提出及神经耳科的对策[J].听力学及言语疾病杂志,2008,16(1):27-29
12 Baloh RW. Vertobrobasilar insufficiency and stroke. Otolaryngol Head Neck Surg,1995, 112: 114- 117
13 Alekseeva NS. Cochlevovestibular syndromed in vertebrobasilar insufficiency. ZhNevrol Psilhiatr Im SS Korsakova, 2004, 104:16-21
14 Trouillas P, Nighoghossian N, Philippon B. Nuclear hemodynamic vertebrobasilar insufficiency. Arch Nenrol, 1991,48: 921
15郑思竟主编.系统解剖学.第3版.北京:人民卫生出版社,1992.361
16黄选兆主编.耳鼻咽喉科学.第3版.北京:人民卫生出版社,1990.228
17 Kim JS, Lopez I, DiPatre PL, et al. Internal auditory artery infarction: clinicopathologic correlation [J]. Neurology, 1999,52 :40
18李敬武,刘怀军,李晖,等.椎一基底动脉病变类型:3.0T MR与MRA观察.中国医学影像技术,2008,24(11):1718-1720
19 Schulz R,Fegbeutel C,Althoff A,et a1.Central sleep apnoea and unilateral diaphragmatic paralysis associated with vertebral artery co- mpression of the medulla oblongata [J].J Neural,2003,250 (4): 503-505
20宋利宏,刘怀军,李晖,等.基底动脉过长弯曲的3.0TMRI研究[J].山东医药,2009,45(9):71-72
21庄晓荣,童绥君,林晓芳.小脑前下动脉梗死的临床特征及病因探讨[J].中风与神经疾病杂志,2003,20(11):422—423
22 Tohgi H, Takahashi S, Chiba K, et a1.Cerebellar infarction.Clinical and neuroimaging analysis in 293 patients.The Tohoku Cerebellar Infarction Study Group [J].Stroke, 1993,24(I1):l697一l7O1
23 Isao Kato, Sadao Ogino , Tomoyuki Okada, et al. Wallenberg’s syndrome: neurotological classification. Auris, Nasus, Larynx,2003,30:13-18
24 Wilkins R, Brody I. Wallenberg’s syndrome. Arch Neurol, 1970, 22:613
25曾司鲁,高摄渊,李旭光,等.脑血管解剖学[M].北京科学出版社,1983:83—85
26张英华,高国栋,刘怀军,等.CT和多种MRI成像方法在突发性耳聋中的选择和应用[J].河北医药,2009,31(16):2124-2126
27 Passero S, Rossi S, Giannini F, et al. Brain2stem comp ression in vertebr obasilar dolichoectasia . A multi modal electrophysiological study . Clin Neurophysiol , 2001,112: 1531
28 Bruzzone MG , Grisoli M, De Simone T, et al. Neuroradiological features of vertigo [J]. Neurol Sci, 2004, 25:S20–S23
29 Dumas G, Schmerber S, Boulat E, et al. Cavernous angiomas of the brainstem: auditory and vestibula manifestations. Rev Laryngol Otol Rhinol.2001; 122:103-110
30乔胜铎,邱建华,苏钰,等.小脑下前动脉与前庭蜗神经关系的解剖学观察.解剖学报2005,36(2):210-211
31徐宏兵,齐滕贵德,黄公怡,等.受压迫神经内血流量变化的研究[J].中华骨科杂志,2000,20(10):298-600
32 Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology. Laryngoscope, 1992, 102: 1030-1036
33 Ryu H, Yamamoto S, Sugiyama K, et al. Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptom? Acta Neurochir.1999;141:495-501
34龚万庆,陶晓峰,高欣,等.MRI高分辨率3D序列检测血管性神经压迫[J].华南国防医学杂志,2009,23(3):28—30
35 Casselman JW. Diagnostic imaging in clinical neuro-otology. Current Opinion in Neurology, 2002, 15:23–30
36 McCarthy R M, Shea S M, Deshpande VS, et al. Coronary MR angiography: true FISP imaging improved by prolonging breath holds with preoxygenation in healthy volunteers. Radiology, 2003, 227:283
1乔胜铎,邱建华,苏钰,等.小脑下前动脉与前庭蜗神经关系的解剖学观察[J].解剖学报,2005,36(2):210-211
2 Cosar M, Yaman M, Eser O, et al. Basilar artery angulation and vertigo due to the hemodynamic effect of dominant vertebral artery[J]. Medical Hypotheses,2008,70:941–943
3赵义. 115例前庭系统性眩晕患者脑干听觉诱发电位分析[J].中国实用神经疾病杂志,2006,9(2):57-58
4吕凡,黄魏宁.血管性眩晕[J].国外医学耳鼻咽喉科学分册2004,28(4):209-213
5苗顺来,佟树文,裴香莲,等.小脑下前动脉综合征[J].中国临床耳鼻咽喉头颈外科,2007,21(10):476
6徐宏兵,齐滕贵德,黄公怡,等.受压迫神经内血流量变化的研究[J].中华骨科杂志2000,20(10):298-600
7 Schwaber MK, Whetsell WO. Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology. Laryngoscope,1992,102: 1030-1036
8石晓花,冯雪玲,沈琼霞,等.脑干听觉诱发电位在老年人椎基底动脉供血不足的诊断价值[J].中风与神经疾病杂志,2009,26(2):228-230
9魏梦绮,宦怡,葛雅丽,等.DWI及FLAIR技术在急性脑梗塞中的临床应用探讨[J].实用放射学杂志,2003,19(3):204-207
10徐冉.磁共振对脑梗死责任病灶的显示情况分析[J].实用医技杂志,2008,15(1):4-5
11 Fujita N, Yamanaka T, Hosoi H, et al. Usefulness of MR angiography in cases of central vertigo[J]. Auris, Nasus, Larynx,2002,29:247-252
12黄胜,龚沈初,姜洪标.3D TOF MRA与3D CE MRA对脑血管病的诊断价值[J].南京医科大学学报,2006,26(12):1257-1260
13张英华,高国栋,刘怀军,等. 3D-FIESTA-C序列在突发性耳聋诊断中的应用[J].河北医药,2009,31(17):2261-2262
14 Nail Bulakba??, Yüksel Pabu??u. Neuro-otologic applications of MRI[J]. Neuroradilogy. 2007,13:109–120
15张迪,路虹.磁共振成像在耳科疾病诊治中的应用[J].中华耳鼻咽喉头颈外科杂志,2005,40(2):156-158
16 Yamasoba T, Kikuchi S, Higo R. Deafness associated with vertebrobasilar insufficiency[J]. Neurological Sciences,2001,187:69–75
17李自如,郭力军.椎-基底动脉供血不足性眩晕的MRA改变及临床分析[J].中国老年学杂志,2007,27:2416-2417
18 Choi KD, Chun JU, Han MG, et al. Embolic internal auditory artery infarction from vertebral artery dissection[J]. J Neuro Sci. 2006,246: 169–172
19 Lee H, Ahn BH, Baloh RW, et al. Sudden deafness with vertigo as a sole manifestation of anterior inferior cerebellar artery infarction[J]. J Neurol Sci,2004,222:105–107
20 Tohgi H,Takahashi S, Chiba K,et al.Cerebellar infarction: Clinical and neuroimaging analysis in 293 patients[J].Strote,1993,24:1679-1701.
21 Bruzzone MG, Grisoli M, De Simone T, et al. Neuroradiological features of vertigo[J]. Neurol Sci, 2004, 25:S20–S23
22张英华,高国栋,刘怀军,等.CT和多种MRI成像方法在突发性耳聋中的选择和应用[J].河北医药,2009,31(16):2124-2126
23 Passero S, Rossi S, Giannini F, et al. Brain2stem comp ression in vertebr obasilar dolichoectasia . A multi modal electrophysiological study . ClinNeurophysiol , 2001,112: 1531
24李晖,刘怀军,杨桦,等.椎-基底动脉病变引起脑干形态及位置变化的3.0TMRI研究[J].临床放射学杂志,2008,27(9):1171-1175
25 Dumas G, Schmerber S, Boulat E, et al. Cavernous angiomas of the brain stem: auditory and vestibular manifestations. Rev Laryngol Otol Rhinol,2001,122:103-110
26 Weissman JL, Hirsch BE. Imaging of tinnitus: a review [J] .Radiology, 2000, 216:342-349
27王冰,王振常,鲜军舫,等.正常人内听道段神经、血管MRI表现[J].中国医学影像技术,2007,23(4):503-506
28 Ryu H, Tanaka T, Yamamoto S, et al. Magnetic resonance cisternography used to determine precise topography of t he facial nerveand t hree component s of t he eight h cranial nerve in the internal auditory canal and cerebellopontine cistern[J]. J Neurosurg,1999,90(4) :624-634
29 Ryu H,Yamamoto S,Sugiyama K,et al,Neurovascular decompression of the eighth cranial nerve in Patients with hemifacial spasm and incidental tinnitus:an alternative way to study tinnitus[J]. J Neurosurg. 1998,88(2):232一236
30 Krombach GA, Schmitz-Rode T, Tacke J, et al. MRI of the inner earcomparison of axial T2-weighted, a three dimensional turbo spinechoimages,maximum intensity projections, and volume rendering[J]. Invest Radiol, 2000, 35:337-342
30 Sirikci A,Bayazit Y,Ozer E,et al. Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms [J]. Surg Radiol Anat,2005, 27(6):531-535
31 Okumura Y , Suzuki M , Takemura A,et al . Visualization of the lower cranial nerves by 3D-FIESTA [J]. Nippon Hoshasen Gijutsu Gakkai Zasshi,2005,61(2):291-297
32 Gultekin S, Celik H, Akpek S,et al. Vascular loops at the cerebellopontine angle: is there a correlation with tinnitus? J Neuroradiol, 2008,29(9):1746-1749
33 Sertac Yetiser, Mustafa Kertmen, Altan Yildirim.An analysis of correlation between the unusual location of thejugular bulb and audiovestibular symptoms。Auris Nasus Larynx, 2004,31:369–377.
34 Casselman JW. Diagnostic imaging in clinical neuro-otology. Current Opinion in Neurology, 2002, 15:23–30
35韩博,杨广夫,何滨,等.颈静脉球MRV成像研究[J].中国临床医学影像杂志,2008,19(11):809-811