【作者】 葛亮；

【导师】 张晓龙；

【作者基本信息】 复旦大学 ， 影像医学与核医学， 2012， 硕士

【摘要】 [研究背景及目的]：颈部动脉夹层是青年及中年人脑卒中的重要原因,其临床表现多变。传统的数字减影血管造影(digital subtraction angiography,DSA)一直被认为是诊断颈部动脉夹层的金标准,近年来CT血管造影检查临床上越来越多用于非侵入性的替代检查方法。本研究的目的在于对比256排CT血管造影(CT angiography,CTA)和DSA、MR T1脂肪抑制加权序列(MRT1-weighted fat-suppressed, MRT1-FS)诊断颈部动脉夹层常见影像学征象的敏感性。[材料及方法]：采用回顾性分析方法,收集自2010年2月至2012年3月复旦大学附属华山医院放射介入及神经内科收治经DSA或M R T1-FS确诊为颈部动脉夹层的连续患者。回顾性分析其256排CTA的影像学征象,包括血管狭窄、内膜瓣、双腔征、血管闭塞、管壁增厚(内膜血肿)以及夹层动脉瘤形成等。[结果]：本研究包合58例连续病人(男性40例,平均年龄46.9±11.9岁),共68处动脉夹层病变(前循环29例,后循环39例)。与DSA相比CTA可以显示85%的内膜瓣(22/26),67%的双腔征(4/6),CTA显示血管狭窄有很高的敏感性94%(33/35)。显示夹层动脉瘤及血管闭塞两者无差别。相比MR T1-FS,256排CTA亦可以很好的显示血管内膜增厚。[总结]：本研究正式256排CTA可以清晰显示包括血管腔及管壁在内颈部动脉夹层的多种影像学征象,是诊断颈部动脉夹层快速而有效的影像学方法,对指导临床选择合适的介入治疗方法有重要意义。更多还原

【Abstract】 BACKGROUND AND PURPOSE:Cervical artery dissection (CAD) is an important cause of stroke in young and middle-aged patients, it can cause a variety of clinical presentations. Conventional digital subtraction angiography (DSA) has been historically considered as the gold standard for the diagnosis of cervical artery dissection, nowadays CT angiography (CTA) are commonly used as noninvasive alternatives. The goal of this study was to compare the ability of256-slice CTA, conventional angiography and MR T1-weighted fat-suppressed (MR T1-FS) images to detect common imaging findings of cervical artery dissection.MATERIALS AND METHODS:Patients between Feb2010and Mar2012with CAD assessed by DSA or MR T1-FS imaging were conducted. Radiological features of CAD on256-slice CTA were reanalyzed, including vessel stenosis, intimal flap, double lumen sign, occlusion, wall thickening/hematoma and dissecting aneurysm.RESULTS:Fifty-eight patients(40males, mean age46.9±11.9years)with a total of68dissections(29carotid arteries and39vertebrobasilar arteries) were reviewed retrospectively. Compare to DSA256-slice CTA demonstrate intimal flap in22/26(85%), the double lumen sign was detected in4/6(67%), lumen stenosis was clearly illustrated in33/35(94%). Dissecting aneurysm, vessel occlusion displayed with CTA and DSA were deemed equal. CTA can demonstrate wall thickening well compare to MR T1-FS images.CONCLUSION:Our findings confirm that256-slice CTA is capable of visualizing more features associated with dissections, which can be a quick and reliable technique in diagnosing CAD.更多还原