【作者】 张伟；

【导师】 刘恒兴； 付升旗；

【作者基本信息】 新乡医学院 ， 人体解剖与组织胚胎学， 2016， 硕士

【摘要】 背景随着社会进步和人们生活水平的提高,脑血管病已经成为人类疾病的3大死亡原因之一,死亡率和发病率均较高,50%~70%的存活人群遗留有失语、瘫痪等严重残疾,给社会和家庭带来了沉重的负担。MRA、CTA、DSA影像可以对脑血管进行活体观测,为临床疾病的诊断和治疗提供客观依据。目的利用MRA、CTA、DSA影像技术,观测各脑动脉血管造影的长度、直径、夹角之间及其与标本之间的差异,以及在脑动脉狭窄、脑动脉瘤诊断上的应用价值,为脑血管病变的筛选、影像诊断、介入治疗等提供形态学依据。方法收集新乡医学院第一附属医院放射科,2014年1月至2015年12月期间,施行脑血管检查者200例,且排除动脉狭窄、动脉瘤、脑血管畸形等病变,男性100例,女性100例,年龄19~67岁,作为正常组;经影像检查和手术证实为动脉狭窄、动脉瘤、脑血管畸形100例,男性50例,女性50例,年龄18~60岁,作为病变组。选取新乡医学院解剖学实验室的成人尸体头部标本20例,经双侧翼点入路对脑血管进行解剖、观测,作为标本组。正常组脑血管检查者和脑血管病变组均采用MRA、CTA、DSA技术进行血管造影和图像后处理,使用工作站内的软件系统,测量主要脑动脉的径线、角度。测量数据采用SPSS 13.0软件进行统计学处理,计量资料采用均数±标准差((?)±s)表示。结果1.MRA、CTA、DSA影像可以清晰显示脑动脉及其主要分支。大脑前动脉A1段、大脑中动脉M1段、大脑后动脉P1段、基底动脉的长度、直径和大脑中动脉M1段远端夹角、基底动脉顶端夹角、双侧大脑前动脉A2段夹角,在MRA与CTA之间、MRA与DSA之间、CTA与DSA之间和DSA影像与标本的夹角之间,均无显著性差异(P>0.05),MRA、CTA、DSA影像与标本之间的长度、直径均有显著性差异(P<0.05),标本测量值大于DSA、MRA、CTA影像值。2.DSA影像可以较清晰显示脑动脉的中央支,大脑前动脉、大脑中动脉、大脑后动脉中央支的数目、直径与标本之间有显著性差异(P<0.05),DSA的数目和直径均小于标本。DSA和标本中央支的直径分别为(0.29±0.03)mm、(0.32±0.02)mm、(0.41±0.06)mm和(0.36±0.02)mm、(0.37±0.04)mm、(0.47±0.04)mm。3.在脑动脉病变的MRA、CTA、DSA影像上,DSA对动脉狭窄的显示率与手术结果一致,与MRA、CTA的显示率、灵敏度之间有显著性差异(P<0.05),DSA对动脉狭窄的显示率、灵敏度大于MRA、CTA。CTA对动脉瘤的显示率与手术结果一致,与MRA、DSA的显示率、灵敏度之间有显著性差异(P<0.05),CTA对动脉瘤的显示率、灵敏度大于MRA、DSA。MRA、CTA、DSA对脑血管畸形的显示率与手术结果一致,显示率、灵敏度之间无显著性差异(P>0.05)。4.在动脉狭窄的DSA影像上,介入治疗前、后的大脑前动脉A1段、大脑中动脉M1段、大脑后动脉P1段、基底动脉的管径、狭窄程度之间有显著性差异(P<0.05),介入治疗后的DSA影像与正常影像组之间有显著性差异(P<0.05),介入治疗后的动脉管径小于正常组。5.在动脉瘤的MRA、CTA、DSA影像上,动脉瘤组与正常组的大脑中动脉M1段远端夹角、基底动脉顶端夹角、双侧大脑前动脉A2段夹角之间有显著性差异(P<0.05),动脉瘤组的夹角大于正常组,动脉瘤组DSA影像和正常组分别为(153.96±8.50)°、(193.54±7.73)°、(141.93±10.95)°和(91.86±5.37)°、(91.60±4.71)°、(98.93±4.60)°。瘤体最大径、瘤体短径、瘤颈和相同部位动脉瘤影像检出率之间均无显著性差异(P>0.05)。动脉瘤的发生部位有显著性差异(P<0.05),大脑前动脉与前交通动脉连接处动脉瘤的发生率最高。结论1.MRA、CTA、DSA可以清晰显示脑动脉及其主要分支,对指导临床手术治疗和支架内植入术有重要的指导价值。2.在筛查、诊断脑血管病时,DSA、CTA分别是检查动脉狭窄和动脉瘤的最佳方法,MRA、CTA、DSA影像检查相互结合,可以提高脑血管病的诊断率。更多还原

【Abstract】 Background Along with the social progress and the improvement of people’s living standard,cerebrovascular disease had become one of the three major causes of death of human diseases,morbidity and mortality were higher,50% ~ 70% of the survival had severe disabilities,such as paralysis,aphasia,which brought a heavy burden to family and society.MRA,CTA and DSA images could be used for in vivo observation of cerebrovascular,and therefore provide the basis for clinical diagnosis and treatment of disease.Objective To observe the length,diameter,angle of cerebral artery angiography,and the differences between the images and specimens,artery stenosis,aneurysm patients and for screening of cerebrovascular disease by using MRA,CTA and DSA imaging techniques,imaging diagnosis and interventional therapy and to provide morphological basis for imaging diagnosis and interventional therapy.Methods Images of 200 cases of cerebrovascular inspectors in the First Affiliated Hospital of Xinxiang Medical University from January 2014 to December 2015 were collected,in which the symptoms of artery stenosis,aneurysms,vascular malformations disease was eliminated,there were 100 cases of male and 100 cases of female in the normal group,aged 19 to 67 years old.Confirmed by imaging examination and operation for 100 cases artery stenosis,aneurysms,vascular malformations,there were 50 cases of male and 50 cases of female in the lesions group,aged 18 to 60 years old.Twenty cases adult head specimens of Xinxiang Medical University anatomy laboratory were selected as specimen group,the double flank of cerebrovascular anatomy point were chosen into the road.Normal cerebrovascular inspectors and patients with cerebrovascular lesions were all received MRA,CTA,DSA angiography and image post-processing technology,using the software system within the workstation,measured the diameter and angle of main cerebral artery.Using SPSS 13.0 software for statistical data after processing,measurement data was used mean±standard((?)±s)deviation.Results 1.MRA,CTA and DSA images could clearly show the cerebral arteries and their main branches.The length and diameter of the A1 segment of anterior cerebral artery,M1 segment of middle cerebral artery,P1 segment of posterior cerebral artery,basal artery and the angle of the M1 segment distal of middle cerebral artery,the top of basilar artery,the double side A2 segment of anterior cerebral artery,the length and diameter between the MRA and CTA images,the MRA and DSA images,the CTA and DSA,angle of the DSA and specimens,there were no significant difference(P > 0.05),the length and diameter between the MRA,CTA,DSA images and specimen,there were significant difference(P < 0.05),the specimen was greater than the DSA,MRA,CTA images.2.DSA images could clearly show the central branch of cerebral arteries,the number and diameter of the anterior cerebral artery,middle cerebral artery,posterior cerebral artery and specimens,there were significant difference(P < 0.05),the number and diameter of DSA were less than the specimens.The diameter of the central branch of DSA and specimens were(0.29±0.03)mm,(0.32±0.02)mm,(0.41±0.06)mm and(0.36±0.02)mm,(0.37±0.04)mm,(0.47±0.04)mm respectively.3.On the cerebral artery lesions of the MRA,CTA and DSA image,the detection rate of DSA for artery stenosis was consistent with the surgical results,the rate and sensitivity between the DSA and the MRA,CTA,there was significant difference(P < 0.05),the detection rate and sensitivity of DSA for artery stenosis were greater than that of the MRA,CTA.The detection rate of aneurysms between the CTA and the surgical results were consistent,the rate and sensitivity between the DSA and the MRA,DSA,there was significant difference(P < 0.05),the detection rate and sensitivity of CTA for aneurysms was greater than the MRA,DSA.The MRA,CTA and DSA in vascular malformations of the detection rate consistent with the surgical results,the detection rate and sensitivity,there was no significant difference(P > 0.05).4.On the artery stenosis of the DSA image,before and after interventional therapy of the A1 segment of anterior cerebral artery,M1 segment of middle cerebral artery,P1 segment of posterior cerebral artery,basal artery,the diameter and degree of stenosis,there were significant difference(P < 0.05),there was significant difference between the after interventional therapy of DSA images and the normal group(P < 0.05),after interventional therapy of arterial diameter was less than the normal group.5.On the aneurysm of MRA,CTA and DSA images,the aneurysm group and normal group in the angle of the M1 segment of brains distal artery,the top of basilar artery,the double side A2 segment of anterior cerebral artery,there were significant difference(P < 0.05),the aneurysm angle was greater than the normal group.The aneurysm of DSA images and normal group were(153.96±8.50)°,(193.54±7.73)°,(141.93±10.95)° and(91.86±5.37)°,(91.60±4.71)°,(98.93±4.60)° respectively.Between the image detection rate of the largest diameter,short diameter,tumor neck and the same position,there were no significant difference(P > 0.05),the neurysm location had significant difference(P < 0.05),the connection of anterior cerebral brain with the traffic anterior artery was the highest incidence of aneurysms.Conclusion 1.MRA,CTA and DSA could clearly display the cerebral arteries and their main branches,they had important guidance value to guide clinical therapy and stent implantation.2.In the screening and diagnosis of cerebrovascular disease,the DSA and CTA were the best way to check the artery stenosis and aneurysm respectively,the MRA,CTA and DSA imaging combined with each other,could improve the diagnostic rate of cerebrovascular disease.更多还原