成人型缺血性烟雾病综合征的多模式磁共振成像表现

摘要

目的：分析成人型缺血性烟雾病综合征的多模式磁共振成像（ MRI）表现及其诊断价值。方法收集2012年3月—2014年2月吉林市人民医院诊治的10例成人型缺血性烟雾病综合征患者，回顾分析其MRI平扫、动脉自旋标记法（ASL）脑灌注成像（PWI）、磁敏感成像（SWI）、三维时间飞跃法（3D - TOF）磁共振血管成像（MRA）、匙孔技术四维增强MRA（4D-TRAK-MRA）、MRI增强（CE-MRI）结果。结果 MRI平扫显示双侧大脑前动脉（ ACA）、大脑中动脉（ MCA）的流空信号消失，基底核区出现烟雾状血管流空信号影以及柔脑膜高信号征；ASL-PWI显示ACA、MCA供血区脑血流量（ CBF）减低；SWI显示梗死区缺乏小静脉显影，代偿区柔脑膜周围有多发增粗的小静脉；3D-TOF-MRA直观显示双侧颈内动脉（ICA）末端和ACA、MCA起始端的狭窄或闭塞以及增粗延长的大脑后动脉和脑底部烟雾血管；4D-TRAK-MRA能动态全景显示头颈部血运情况和柔脑膜的侧支循环，对烟雾病综合征诊断分期准确率达90%（9/10）。结论多模式MRI不但可以反映脑实质和颅内血管的情况，而且能提供解剖形态学和功能学两方面的特征，可作为烟雾病综合征筛查、诊断及分期的一种有效的影像学无创检查方法。%Objective To investigate the performance of multi-mode MRI for adult patients with moyamoya disease ( MMD)and its diagnostic value. Methods 10 patients with MMD admitted to Jilin City People's Hospital from March 2012 to February 2014 were selected. The results of MRI plain scan,ASL-PWI,SWI,3D -TOF-MRA,4D -TRAK -MRA and MRI enhanced scan(CE-MRI). Results MRI plain scan showed that flow-void signs of anterior cerebral artery(ACA)and middle cerebral artery( MCA)disappeared,and flow-void signs of moyamoya vessels and leptomeninges high signals appeared in basal ganglia;ASL-PWI showed that the cerebral blood flow( CBF)was reduced in ACA and MCA;SWI showed that the imaging development of small vein was deficient in infarction area,and there were multiple enlarged small veins in leptomeninges of compensation area;3D-TOF-MRA directly showed that the stenosis or occlusion of the tail end of bilateral internal carotid artery( ICA)and head end of ACA and MCA,as well as the thickened and lengthened posterior cerebral artery( PCA)and moy-amoya vessels at the base of brain;4D-TRAK-MRA could show a dynamic panoramic image of blood supply in brain and neck and the collateral circulation of leptomeninges, and it had a accuracy of 90% ( 9/10 ) in diagnosing and grading MMD. Conclusion Multi-mode MRI can reflect the condition of brain parenchyma and intracranial blood vessel both in terms of morphology and function,which is regarded as an effective,non-invasive imaging methods for the screening,diagnosing and staging of MMD.