【摘要】 目的探索可用于辨别影像学上动脉瘤样大脑中动脉(MCA)分支闭塞与MCA分叉部动脉瘤的特征。方法收集3例影像学上表现为动脉瘤样的MCA分支闭塞患者的临床资料,回顾同期20例MCA小动脉瘤(直径≤5 mm)患者的临床资料。回顾5例Pubmed文献数据库上影像学表现为动脉瘤样MCA分支闭塞患者的临床资料。比较动脉瘤样MCA分支闭塞和MCA分叉部小动脉瘤临床资料和影像学特征,包括MCA分支数量、动脉瘤外观(圆锥状、柱状和囊状)、动脉瘤高(Ha)、动脉瘤宽(Wa)、动脉瘤颈宽(Wn)、动脉瘤水平分支最大宽度(Wb)、是否合并烟雾血管和动脉瘤比例参数(Ha/Wa>1、Wa/Wn≤1和Wa/Wb≤1)。结果 t检验和Fisher检验结果显示,两组间圆锥状(P=0.015)、囊状(P=0.011)、Wa/Wn≤1(P=0.011)、Wa/Wb≤1(P=0.022)的差别具有统计学意义。logistic多因素分析结果显示,圆锥形状(P=0.046)和Wa/Wb≤1(P=0.031)为MCA分支闭塞与MCA分叉部动脉瘤相关的特征。结论诊断MCA分叉部动脉瘤时,若动脉瘤为圆锥状且宽小于相同水平分支最大宽度时,应考虑MCA闭塞的可能性。可通过高分辨率磁共振进一步明确诊断。更多还原

【Abstract】 Objective The aim of this study was to explore reliable features that can be used to differentiate the stump of occluded middle cerebral artery(MCA) branch from real MCA branch aneurysms, and to propose same warning notes. Method This study reported 3 patients with MCA branch occlusion mimicking an bifurcation aneurysm. Then, we reviewed the literature and described the characteristics of all pooled MCA branch occlusion patients. The pooled MCA branch occlusion patients were compared with real small MCA aneurysms(≤5 mm) diagnosed at the same period of that 3 cases reported in this study. The clinical and radiological information, including branch number of MCA, aneurysm appearance(conic, columnar and saccular), height of the aneurysm(Ha), width of the aneurysm(Wa), width of the aneurysm neck(Wn), width of the largest branch of MAC at the same level of protruding lesion(Wb), moyamoya vessels, ratio of aneurysm parameters(Ha/Wa>1, Wa/Wn≤1 and Wa/Wb≤1) were retrieved and compared. Results According to the t test and Fisher test, conic shape(P=0.015), saccular shape(P=0.011) Wa/Wn≤1(P=0.011), Wa/Wb≤1(P=0.022), were significantly associated with artery occlusion. However, the results of multivariate analysis showed that only conic shape(P=0.046) and Wa/Wb≤1(P=0.031) were the independent features related with MCA major branch occlusion. Conclusions In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered when the lesion is conic shape and with a diameter smaller than the largest opening branch at the same level. High resolution magnetic resonance imaging may be needed for differential diagnosis.更多还原