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| 头颈动脉夹层药物治疗前后的高分辨率磁共振成像特征分析 |
| 李帅△,李凘纯△,张雪凤*,彭雯佳,田冰,田霞,陈录广,侯雨希,刘崎,陆建平,邵成伟 |
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(海军军医大学(第二军医大学)第一附属医院放射诊断科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 分析自发性未破裂头颈动脉夹层（CCAD）患者药物治疗前后高分辨率磁共振成像（HR-MRI）特征变化。方法 回顾性连续收集2015年8月至2022年12月于海军军医大学（第二军医大学）第一附属医院确诊并在药物治疗前后行HR-MRI检查的30例CCAD患者资料。根据随访时磁共振血管成像（MRA）图像上夹层血管管腔狭窄的改善情况，将患者分为改善组（随访时管腔狭窄程度较基线减轻1个级别及以上的患者）与未改善组（随访时管腔狭窄程度较基线加重1个级别及以上或无变化的患者）。分析改善组与未改善组患者的临床资料及治疗前后HR-MRI管腔及管壁特征差异。结果 30例CCAD患者共计30处夹层，其中改善组14例（11例完全恢复正常，3例管腔狭窄程度改善）、未改善组16例。改善组患者的年龄小于未改善组［（37.86±9.83）岁vs（56.94±9.86）岁，P＝0.001］，其余临床特征差异均无统计学意义（P均＞0.05）。改善组患者中基线壁内血肿比例高、管腔狭窄程度相对较轻，而未改善组患者的基线管腔狭窄程度较严重，内膜瓣与双腔征、假腔内血栓形成更常见（P均＜0.05）。治疗后随访时，改善组患者壁内血肿、管腔狭窄程度均改善，未改善组患者壁内血肿、内膜瓣与双腔征、假腔内血栓形成仍有较多残留（P均＜0.05）。两组基线夹层血管壁强化程度差异无统计学意义（P＞0.05），治疗后随访时改善组患者血管壁强化程度较未改善组降低（P＜0.001）。结论 HR-MRI可对CCAD药物治疗前后管腔及管壁形态学特征变化进行评估，年龄小、基线管腔狭窄程度相对较轻的患者经药物治疗后夹层恢复好。 |
| 关键词: 头颈动脉夹层 高分辨率磁共振成像 抗凝剂 抗血小板药 预后 青年脑卒中 |
| DOI：10.16781/j.CN31-2187/R.20230123 |
| 投稿时间：2023-03-19修订日期：2023-04-25 |
| 基金项目:国家自然科学基金（82202126），上海市自然科学基金（22ZR1478100），上海市科学技术委员会医学创新研究专项（22Y11911200）. |
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| High-resolution magnetic resonance imaging characteristics of cervicocranial arterial dissection before and after drug treatment |
| LI Shuai△,LI Si-chun△,ZHANG Xue-feng*,PENG Wen-jia,TIAN Bing,TIAN Xia,CHEN Lu-guang,HOU Yu-xi,LIU Qi,LU Jian-ping,SHAO Cheng-wei |
(Department of Radiology, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To analyze the changes of high-resolution magnetic resonance imaging (HR-MRI) characteristics in patients with spontaneous unruptured cervicocranial arterial dissection (CCAD) before and after drug treatment. Methods The data of 30 CCAD patients who were diagnosed in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Aug. 2015 to Dec. 2022 and underwent HR-MRI before and after drug treatment were retrospectively and continuously collected. According to the improvement of the stenosis of dissecting vessels on magnetic resonance angiography (MRA) at follow-up, the patients were divided into improvement group (the patients who had a reduction of 1 grade or more in the lumen stenosis at follow-up compared with baseline) and unimprovement group (the patients who had an increase of 1 grade or more or no change in the lumen stenosis at follow-up compared with baseline). The differences in clinical data of patients in the improvement group and unimprovement group, as well as the lumen and wall characteristics of HR-MRI before and after treatment, were analyzed. Results A total of 30 dissections were found in the 30 CCAD patients, including 14 in the improvement group (11 completely returned to normal and 3 improved in the lumen stenosis) and 16 in the unimprovement group. The age of patients in the improvement group was significantly younger than that in the unimprovement group (［37.86±9.83］ years old vs ［56.94±9.86］ years old, P＝0.001), and there were no significant differences in other clinical characteristics (all P＞0.05). At baseline, in the improvement group the proportion of intramural hematoma was higher and the lumen stenosis was relatively mild, while in the unimprovement group the lumen stenosis was severe, and the intimal flap, double lumen sign and pseudolumen thrombosis were more common (all P＜0.05). At follow-up, intramural hematoma and the degree of lumen stenosis in the improvement group were significantly improved, while there were still many residual intramural hematoma, intimal flap, double lumen sign, and pseudolumen thrombus in the unimprovement group (all P＜0.05). At baseline, there was no significant difference in the enhancement of the dissection vessel wall between the 2 groups (P＞0.05). At follow-up, the enhancement of the dissection vessel wall in the improvement group was significantly decreased compared with the unimprovement group (P＜0.001). Conclusion HR-MRI can be used to evaluate the morphological changes of the lumen and wall of CCAD before and after drug treatment. Patients with younger age and relatively mild lumen stenosis at baseline can achieve better outcomes after drug treatment. |
| Key words: cervicocranial arterial dissection high-resolution magnetic resonance imaging anticoagulants antiplatelet drug prognosis youth stroke |
