高分辨力MR血管壁成像技术在头颈动脉夹层诊断中的应用价值

摘要

目的 探讨高分辨力MRI(HRMRI)在头颈动脉夹层诊断中的价值.方法 前瞻性连续纳入2015年2月—2017年6月于宣武医院就诊的头颈动脉夹层病人30例,采用32通道头颈联合专用线圈行头颈一体化HRMRI成像.由2名神经内科医生根据纳入病人的临床病史、实验室检查、常规影像检查对夹层做出诊断并作为参考标准.由2名放射科医生对CTA和HRMRI影像进行双盲分析,评价内容包括内膜片、壁内血肿及双腔征等.计算CTA和HRMRI在血管节段水平诊断夹层的准确性.结果 ①2名神经内科医生在30例病人中共诊断41个血管节段存在夹层,其中累及颈内动脉18个节段、椎动脉18个节段、基底动脉5个节段.②CTA正确诊断21个血管节段存在夹层(21/41,敏感度51.2%),其中6个血管节段见双腔征.③HRMRI正确诊断39个血管节段存在夹层(39/41,敏感度95.1%),其中36个血管节段见壁内血肿,30个血管节段见双腔征.结论 头颈联合HRMRI可全景显示夹层动脉管壁特征,可作为动脉夹层诊断和随访的一线检查技术.%Objective To investigate the value of high resolution magnetic resonance imaging (HRMRI) in the diag-nosis of head and neck artery dissection. Methods From February 2015 to June 2017,thirty patients with head and neck artery dissection in Xuanwu Hospital were prospectively enrolled. HRMRI was performed with a 32-channel head and neck combined coil. Two neurologists diagnosed dissection based on the clinical history, laboratory tests, and conventional imaging examinations, and the diagnosis was used as a reference standard. CTA and HRMRI images were analyzed separately by two radiologists including intimal flip, intracranial hematoma and double lumen. Diagnostic accuracy of CTA and HRMRI in the detection of dissection at the segmental level was calculated. Results (1) Thirty patients with a total of 41 segments of dis-sected vascular segment were diagnosed by two neurologists, including 18 segments of the internal carotid artery, 18 segments of the vertebral artery, and 5 segments of the basilar artery. (2) Using CTA 21 dissected segments were correctly diagnosed. Sensitivity of CTA was 51.2%(21/41), including 6 segments had double lumen sign. (3) Using HRMRI 39 dissected segments were correctly diagnosed. Sensitivity of HRMRI was 95.1%(39/41), including 36 segments had hematoma, and 30 segments had double lumen sign. Conclusion Head and neck HRMRI can depict the vessel wall characteristics of dissection.The technique may become first line choice in the diagnosis and follow-up of artery dissection.