颈部动脉夹层课件.pptx

1、According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline颈部动脉夹层的颈部动脉夹层的 7 种影像学种影像学征象，你都能识别吗？征象，你都能识别吗？According to the assessment requirements of party co

2、nduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline那么，如何在在那么，如何在在影像学上识别夹影像学上识别夹层？层？颈部动脉夹层是青年卒中的重要病因。国外资料显示，CADs 导致卒中约为所有缺血性卒中的 2%，在小于 45 岁的青年中的比例可高达 8%25%。夹层在传统管腔影像学检查上可表现为内膜瓣、双腔征、壁内血肿、瘤样扩张、串珠征、锥形狭窄及闭

3、塞征象。夹层的诊断标准（SASSY Japan）1：According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplineAccording to the assessment requirements of party conduct and clean gov

4、ernment,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline一、一、MRI/MRA/CTA上的征象上的征象内膜瓣及双腔征 内膜瓣是颈部动脉夹层（cervicocerebral arterial dissections CADs）的直接征象，在 MRI 黑血序列上呈高信号的瓣状结构，位于血管腔中。约半数患者用 T2WI 可显示出内膜瓣，有时可见内膜瓣移位。MRI 增强扫描血管壁和内膜瓣都可见强化

5、，对内膜瓣的显示更佳。双腔征也是 CADs 的直接征象。真腔一般较窄，呈类圆形，为不完全闭塞的血管腔，有血流通过。假腔较宽，多呈新月形，为内膜夹层分离所致。假腔内血流速度多较慢，易形成湍流，在 MRI 上多呈不均匀信号，常见血肿形成。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity

6、 and self-discipline内膜瓣及双腔征图 1 基底动脉夹层：上左图：基底动脉狭窄（箭头）；上右图：DWI 示右侧脑桥腹中间部梗死病灶；下图：T1WI 及 PDI 上可见内膜瓣及双腔According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disciplin

7、e除了常见的椎除了常见的椎-基底动脉及颈内动脉夹层外，高分辨核磁（基底动脉及颈内动脉夹层外，高分辨核磁（HR-MRI）对颅内）对颅内动脉夹层的显示也更优，以下是大脑中动脉（动脉夹层的显示也更优，以下是大脑中动脉（MCA）夹层患者的）夹层患者的 HR-MRI 表表现现 2：图 2 左图：43 岁男性，左侧 MCA 夹层，T2WI HR-MRI 示 M1 段内膜瓣（白箭头）；右图：56 岁女性，左侧 MCA 夹层，T2WI HR-MRI 示 M1 段内膜瓣（白箭头）及小的假腔（黑箭头）；According to the assessment requirements of party conduc

8、t and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline壁内血肿 壁内血肿 3,4 也是 CADs 的典型征象。MRI 显示为受累的动脉管壁增厚，且增厚的管壁边缘光滑；壁内血肿通常导致外管径扩张，信号随时间变化，与血肿成分有关，亚急性期及慢性期早期显示为高信号（含正铁血红蛋白），多呈新月形，邻近管腔多呈偏心性狭窄。一、一、MRI/MRA/CTA上的征象上的征象

9、According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline图 3 基底动脉夹层：A 图：TOF-MRA 示基底动脉中度狭窄，管腔不规则，B 及 C 图：未强化的 T1WI 像上可见偏心性高信号（壁内血肿），D 图：随访发现基底动脉管腔狭窄消失壁内血肿A

10、ccording to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline图 4 大脑前动脉（ACA）夹层：A 图：DWI 示左侧 ACA 供血区梗死；B 图（MRA）及 C 图（DSA）示 ACA A2 段长节段的狭窄（白箭头）；HR-MRI 示高信号的壁内血肿（黑箭

11、头）According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline 壁内血肿在 HR-MRI 上也较常见，但其与斑块内出血较难鉴别。有文献提出，二者在 HR-MRI 上还是有所差异的，斑块内出血常常在出血周围可见非出血成分。According to the

12、 assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline二、二、DSA 上的征象上的征象火焰征、鼠尾征 DSA 上夹层最常见的征象为平滑的锥形狭窄。夹层导致的血管闭塞在 DSA 可表现为火焰征或鼠尾征5。According to the assessment requirement

13、s of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline图 5 左图：DSA 示颈动脉夹层伴鼠尾征；右图：DSA 示颈动脉夹层伴火焰征火焰征、鼠尾征火焰征、鼠尾征According to the assessment requirements of party conduct and clean government,comb

14、ined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline假腔及造影剂滞留 DSA 上可见假腔内造影剂滞留。真腔流速较快，假腔流速较慢，假腔内可见静脉期造影剂滞留。DSA 上的征象上的征象According to the assessment requirements of party conduct and clean government,combined with the five regulations a

15、nd five new requirements of state-owned Enterprise leaders integrity and self-discipline假腔及造影剂滞留假腔及造影剂滞留图 6 右椎动脉夹层瘤：2C 图：MRA 示夹层瘤外部轮廓明显的分为真腔及假腔（箭头）；2D 图：DSA 术中导管头端进入假腔内，微量造影剂仅见假腔及动脉瘤远端的小脑后下动脉显影（箭头示）According to the assessment requirements of party conduct and clean government,combined with the five

16、regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline假腔及造影剂滞留假腔及造影剂滞留图 7 椎动脉夹层：8A 图：动脉期椎动脉对比剂完全充盈（箭头）；8B 图：静脉期可见假腔内造影剂滞留（箭头）According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new r

17、equirements of state-owned Enterprise leaders integrity and self-discipline三、影像学检查流程三、影像学检查流程 以下为 CADs 影像学检查推荐流程：对于存在典型临床症状（出血、缺血、神经功能缺损等）及头颈部外伤史（颅外段夹层的重要病因）的人群，特别是中青年卒中患者，建议行颅内动脉影像学检查以明确或排除夹层病变。According to the assessment requirements of party conduct and clean government,combined with the five reg

18、ulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline影像学检查流程影像学检查流程图 8 颅内动脉夹层病变的推荐影像学检查流程（DWI：弥散加权成像，PWI：灌注加权成像，PDWI：质子加权成像，MP-RAGE：磁化快速梯度回波，SNAP：非对比血管成像与斑块内出血同时成像；HR：高分辨率）According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline谢谢大家！谢谢大家！