颈动脉内膜剥脱术患者T2-FLAIR高信号血管征相关研究

摘要

Purpose To evaluate the correlation between T2-FLAIR hyperintense vessel sign (HVS) and the stenotic degree of internal carotid artery (ICA) and assess the HVS changes after the carotid endarterectomy (CEA). Materials and Methods Fifty-one patients with CEA were retrospectively enrolled. The stenosis of the bilateral ICA were as:≥90%, and<90%. The distribution of HVS locations was classified as three regions:sylvian fissure, sulci of temporo-occipital lobe and other areas. The presence and the location of HVS were counted. The extrension of HVS on T2-FLAIR were graded as:I:the presence of HVS was<1/3 of the MCA territory, II:the presence of HVS was≥1/3 of the MCA territory.χ2-test was performed for correlation between HVS and ICA stenosis. The difference of HVS and stenosis of ICA and their effects on CEA was accessed. Results HVS was significantly higher in the ICA stenosis more than 90%group than in the less than 90% group (χ2=23.584, P<0.001). The frequencies of HVS were 12, 34 and 15 in sylvian fissure, sulci of temporo-occipital lobe and other area, respectively. The proportion of grade II HVS was higher in the ≥ 90% group than in the<90% group (χ2=8.395, P<0.05). After CEA, HVS on 29 affected hemispheres were showed to be disappeared (n=24) or remained (n=5) in the treated side. Conclusion The presence and the grade of HVS were correlated with the stenotic degree of ICA. In the patients with ICA stenosis, HVS was most frequently found in the sulci of temporal lobe and occipital lobe, and seldom found in sylvian fissure. HVS disappeared after CEA indicating that HVS can be considered as a marker for CEA treatment.%目的探讨T2-FLAIR序列高信号血管征（HVS）与颈动脉（ICA）狭窄程度的相关性，评估颈动脉内膜剥脱术（CEA）对HVS的影响。资料与方法回顾性分析51例ICA狭窄患者的临床和影像学资料，将患者分为ICA狭窄程度<90%组和≥90%组。将HVS的分布区域划分为侧裂池、颞枕叶脑沟和其他部位，统计HVS在各区域出现的次数。根据HVS的分布范围，将HVS分为I级（HVS分布范围<1/3大脑中动脉供血区）、II级（HVS分布范围>1/3大脑中动脉供血区）。比较不同狭窄程度HVS的发生率和分级的差别，分析CEA前后ICA及T2-FLAIR序列的变化，评估CEA对HVS的影响。结果 ICA狭窄程度≥90%组HVS的发生率显著高于<90%组，差异有统计学意义（χ2=23.584, P<0.001）。HVS在各区域出现的次数分别为：侧裂池12次，颞枕叶脑沟34次，其他部位15次。ICA狭窄程度≥90%组的HVS II级比例高于<90%组（χ2=8.395, P<0.05）。CEA后24例HVS消失，5例HVS不变。结论 HVS的发生率及等级与ICA狭窄程度具有相关性。ICA狭窄所致HVS多见于颞枕叶脑沟，侧裂池较少见。CEA可以明显改善HVS，术后HVS消失可能成为评估CEA效果的有效指标之一。