高分辨率磁共振成像对颅内动脉病变的精准化诊疗

doi:10.3969/j.issn.1673-5765.2017.08.013

摘要/Abstract

摘要：

血管壁成像（vessel wall imaging，VWI）可以显示除传统管腔影像检测到的简单管腔病变之外的变化，如动脉粥样硬化性斑块形态、动脉管壁和颅内及颈部动脉周围结构组织。我国现有卒中患者600万～700万人/年，46.6%的急性缺血性卒中由颅内血管病变所致。颅内动脉病变病因多（颅内动脉粥样硬化、烟雾病、夹层等），并且颅内动脉血管管径小，位置较深，传统影像学检查方法因其空间分辨率有限，难以发现血管微小病变，不能明确病变性质。正确识别颅内动脉病变原因对其早期诊断、预防和治疗至关重要。而高分辨率磁共振成像（high-resolution magnetic resonance imaging， HR-MRI）具有管壁和管腔双重成像作用，是直接评估颅内动脉疾病的重要并最受欢迎的新兴成像技术。本文旨在通过HR-MRI对颅内动脉病变的精准化诊疗做一综述。

文章导读： 高分辨率磁共振成像可以评估各种颅内血管病变的形态特征，揭示影像学与临床风险的相关性，并获取更精确的诊断来指导治疗和判断预后。

关键词: 高分辨率磁共振; 颅内动脉粥样硬化; 烟雾病; 夹层; 精准化诊疗

Abstract:

Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. There are around 6-7 million cases of stroke every year in china, among which, 46.6% of acute ischemic stroke are caused by cerebrovascular disease. Its pathogen is complicated (intracranial artery atherosclerosis, dissection, Moyamoya disease, etc.); intracranial arterial diameter is small; and the position is relatively deep. It is difficult to find small lesions of vessels and recognize the characteristic because of traditional imaging methods with limited spatial resolution. Correct identification of intracranial arterial disease is essential for early diagnosis, prevention and treatment. However, high-resolution magnetic resonance imaging (HR-MRI) has a dual imaging of the wall and lumen, which is an emerging important and popular technique and can be directly used in the evaluation of intracranial vasculopathies. This article aims to clarify the precision diagnosis and treatment of intracranial arterial lesions through HR-MRI.

Key words: High-resolution magnetic resonance; Intracranial atherosclerosis; Moyamoya disease; Dissection; Precision diagnosis and treatment

徐曼曼，徐运. 高分辨率磁共振成像对颅内动脉病变的精准化诊疗[J]. 中国卒中杂志, 2017, 12(08): 720-724.

XU Man-Man, XU Yun. The Precision Diagnosis and Treatment of Intracranial Arterial Lesions with High-resolution Magnetic Resonance Imaging[J]. Chinese Journal of Stroke, 2017, 12(08): 720-724.

参考文献

[1] JOHNSTON S C，MENDIS S，MATHERS C D. Global

variation in stroke burden and mortality：estimates from

monitoring，surveillance，and modelling[J]. Lancet

Neurol，2009，8（4）：345-354.

[2] DIELEMAN N，VAN DER KOLK A G，

ZWANENBURG J J，et al. Imaging intracranial vessel

wall pathology with magnetic resonance imaging：

current prospects and future directions[J]. Circulation，

2014，130（2）：192-201.

[3] KAMATH S. Observations on the length and diameter

of vessels forming the circle of Willis[J]. J Anat，1981，

133（Pt 3）：419-423.

[4] BODLE J D，FELDMANN E，SWARTZ R H，et

al. High-resolution magnetic resonance imaging：an

emerging tool for evaluating intracranial arterial

disease[J]. Stroke，2013，44（1）：287-292.

[5] SACCO R L，KARGMAN D E，ZAMANILLO M C.

Race-ethnic differences in stroke risk factors among

hospitalized patients with cerebral infarction：the

Northern Manhattan Stroke Study[J]. Neurology，1995，

45（4）：659-663.

[6] GORELICK P B，WONG K S，BAE H J，et al. Large

artery intracranial occlusive disease：a large worldwide

burden but a relatively neglected frontier[J]. Stroke，

2008，39（8）：2396-2399.

[7] WHITE H，BODEN-ALBALA B，WANG C，et al.

Ischemic stroke subtype incidence among whites，blacks，

and Hispanics：the Northern Manhattan Study[J].

Circulation，2005，111（10）：1327-1331.

[8] CHEN X Y，WONG K S，LAM W W，et al. Middle

cerebral artery atherosclerosis：histological comparison

between plaques associated with and not associated with

infarct in a postmortem study[J]. Cerebrovasc Dis，2008，

25（1-2）：74-80.

[9] YUAN C，MITSUMORI L M，FERGUSON M S，et al.

In vivo accuracy of multispectral magnetic resonance

imaging for identifying lipid-rich necrotic cores and

intraplaque hemorrhage in advanced human carotid

plaques[J]. Circulation，2001，104（17）：2051-2056.

[10] YUAN C，ZHANG S X，POLISSAR N L，et al.

Identification of fibrous cap rupture with magnetic

resonance imaging is highly associated with recent

transient ischemic attack or stroke[J]. Circulation，2002，

105（2）：181-185.

[11] XU W H，LI M L，GAO S，et al. Plaque distribution

of stenotic middle cerebral artery and its clinical

relevance[J]. Stroke，2011，42（10）：2957-2959.

[12] HUANG B，YANG W Q，LIU X T，et al. Basilar artery

atherosclerotic plaques distribution in symptomatic patients：

a 3. 0T high-resolution MRI study[J]. Eur J Radiol，2013，

82（4）：e199-203.

[13] KIM B J，YOON Y，LEE D H，et al. The shape of middle

cerebral artery and plaque location：high-resolution MRI

finding[J]. Int J Stroke，2015，10（6）：856-860.

[14] YUAN C，MITSUMORI L M，BEACH K W，et al. Carotid

atherosclerotic plaque：noninvasive MR characterization

and identification of vulnerable lesions[J]. Radiology，2001，

221（2）：285-299.

[15] DEGNAN A J，GALLAGHER G，TENG Z，et al. MR

angiography and imaging for the evaluation of middle

cerebral artery atherosclerotic disease[J]. AJNR Am J

Neuroradiol，2012，33（8）：1427-1435.

[16] TURAN T N，RUMBOLDT Z，GRANHOLM A C，et al.

Intracranial atherosclerosis：correlation between in-vivo

3T high resolution MRI and pathology[J]. Atherosclerosis，

2014，237（2）：460-463.

[17] XU W H，LI M L，GAO S，et al. Middle cerebral

artery intraplaque hemorrhage：prevalence and clinical

relevance[J]. Ann Neurol，2012，71（2）：195-198.

[18] YU J H，KWAK H S，CHUNG G H，et al. Association of

intraplaque hemorrhage and acute infarction in patients

with basilar artery plaque[J]. Stroke，2015，46（10）：2768-

2772.

[19] YAMADA K，YOSHIMURA S，KAWASAKI M，et

al. Embolic complications after carotid artery stenting

or carotid endarterectomy are associated with tissue

characteristics of carotid plaques evaluated by magnetic

resonance imaging[J]. Atherosclerosis，2011，215（2）：

399-404.

[20] U-KING-IM J M，TANG T Y，PATTERSON A，et al.

Characterisation of carotid atheroma in symptomatic and

asymptomatic patients using high resolution MRI[J]. J

Neurol Neurosurg Psychiatry，2008，79（8）：905-912.

[21] SAAM T，FERGUSON M S，YARNYKH V L，et al.

Quantitative evaluation of carotid plaque composition by in

vivo MRI[J]. Arterioscler Thromb Vasc Biol，2005，25（1）：

234-239.

[22] SWARTZ R H，BHUTA S S，FARB R I，et al. Intracranial

arterial wall imaging using high-resolution 3-tesla contrastenhanced

MRI[J]. Neurology，2009，72（7）：627-634.

[23] RYU C W，JAHNG G H，SHIN H S. Gadolinium

enhancement of atherosclerotic plaque in the middle

cerebral artery：relation to symptoms and degree of

stenosis[J]. AJNR Am J Neuroradiol，2014，35（12）：

2306-2310.

[24] SAAM T，YUAN C，CHUN B，et al. Predictors of

carotid atherosclerotic plaque progression as measured

by noninvasive magnetic resonance imaging[J].

Atherosclerosis，2007，194（2）：e34-42.

[25] XU W H，LI M L，GAO S. Intracranial plaque regression

after intensive medical treatments：a high-resolution MRI

observation[J]. Ann Transl Med，2014，2（8）：82.

[26] CHUNG J W，HWANG J，LEE M J，et al. Previous statin

use and high-resolution magnetic resonance imaging

characteristics of intracranial atherosclerotic plaque：the

intensive statin treatment in acute ischemic stroke patients

with intracranial atherosclerosis study[J]. Stroke，2016，47

（7）：1789-1796.

[27] SHI M，WANG S，ZHOU H，et al. Wingspan stenting

of symptomatic middle cerebral artery stenosis and

perioperative evaluation using high-resolution 3 Tesla

MRI[J]. J Clin Neurosci，2012，19（6）：912-914.

[28] YUAN M，LIU Z Q，WANG Z Q，et al. High-resolution

MR imaging of the arterial wall in moyamoya disease[J].

Neurosci Lett，2015，584：77-82.

[29] KIM J M，JUNG K H，SOHN C H，et al. High-resolution

MR technique can distinguish moyamoya disease from

atherosclerotic occlusion[J]. Neurology，2013，80（8）：775-

776.

[30] RYOO S，CHA J，KIM S J，et al. High-resolution magnetic

resonance wall imaging findings of Moyamoya disease[J].

Stroke，2014，45（8）：2457-2460.

[31] XU Y Y，LI M L，GAO S，et al. Non-moyamoya vessel

network formation along steno-occlusive middle cerebral

artery[J]. Neurology，2016，86（21）：1957-1963.

[32] DEBETTE S，COMPTER A，LABEYRIE M A，et

al. Epidemiology，pathophysiology，diagnosis，and

management of intracranial artery dissection[J]. Lancet

Neurol，2015，14（6）：640-654.

[33] WANG Y，LOU X，LI Y，et al. Imaging investigation of

intracranial arterial dissecting aneurysms by using 3 T

high-resolution MRI and DSA：from the interventional

neuroradiologists' view[J]. Acta Neurochir （Wien），2014，

156（3）：515-525.

[34] TAKANO K，YAMASHITA S，TAKEMOTO K，et al.

MRI of intracranial vertebral artery dissection：evaluation

of intramural haematoma using a black blood，variable-flipangle

3D turbo spin-echo sequence[J]. Neuroradiology，2013，

55（7）：845-851.

[35] MIZUTANI T. Natural course of intracranial arterial

dissections[J]. J Neurosurg，2011，114（4）：1037-1044.