Objective： To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging （HRMR VWI） for intracranial arterial stenosis. Date Sources： We retrieved information from PubMed ...Objective： To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging （HRMR VWI） for intracranial arterial stenosis. Date Sources： We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging （VWI）, high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. Study Selection： We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. Results： VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies （atherosclerotic or nonatherosclerotic） had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. Conclusions： This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.展开更多
目的研究头颈动脉高分辨率磁共振血管壁成像(HR-VWI)对隐匿性卒中病因精准诊断的临床应用价值。方法选择经过临床评估及血管腔评估不能确定病因或不能确定治疗方案,而行HR-VWI的卒中患者共21例进行分析,观察HR-VWI对血管壁病变的诊断能...目的研究头颈动脉高分辨率磁共振血管壁成像(HR-VWI)对隐匿性卒中病因精准诊断的临床应用价值。方法选择经过临床评估及血管腔评估不能确定病因或不能确定治疗方案,而行HR-VWI的卒中患者共21例进行分析,观察HR-VWI对血管壁病变的诊断能力。结果HR-VWI发现颈动脉蹼2例,在行HR-VWI之前怀疑心源性卒中的头颈动脉夹层4例,成人型烟雾病(MMD)4例,动脉粥样硬化性烟雾综合征(AS-MMS)4例,中枢神经系统血管炎7例(其中原发性中枢神经系统血管炎3例,巨细胞动脉炎2例,系统性红斑狼疮1例,桥本脑病1例),均行HR-VWI后明确病因并确定治疗方案。其中,对比MMD,AS-MMS在HR-VWI中出现偏心性斑块更多、强化更明显,狭窄处外壁面积更大[(0.0925±0.0220)cm2 vs(0.0461±0.0291)cm2],重构指数更高(0.51±0.10 vs 0.36±0.15)。结论HR-VWI在隐匿性卒中病因诊断中具有重要鉴别价值,能表现各类血管壁病变的典型特征,可在血管标准评估及高级评估之后尽早执行。展开更多
目的通过应用高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)及CT灌注(computed tomography perfusion,CTP)成像对症状性大脑中动脉(middle cerebral artery,MCA)粥样硬化狭窄患者的斑块...目的通过应用高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)及CT灌注(computed tomography perfusion,CTP)成像对症状性大脑中动脉(middle cerebral artery,MCA)粥样硬化狭窄患者的斑块特征及血流灌注进行分析,探寻与急性脑梗死(acute cerebral infarction,ACI)相关的高危影像特征。材料与方法回顾性分析64例发病时间小于4周的症状性MCA粥样硬化狭窄患者的HRMR-VWI及CTP影像资料。根据扩散加权成像(diffusion weight imaging,DWI)和临床表现,将患者分为ACI组和短暂性脑缺血发作(transient ischemic attack,TIA)组,分析两组斑块特征、灌注参数及侧支评分的差异,构建多变量Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线、计算曲线下面积(area under the curve,AUC),评估显著变量及其联合模型对ACI预测价值。结果共纳入64例患者。TIA组共25例,女10例,年龄(55.12±11.20)岁。ACI组共39例,女11例,年龄(57.90±9.62)岁。两组间性别(P=0.327)、年龄(P=0.296)差异无统计学意义。与TIA组相比,ACI组的斑块长度更长[6.10(3.20,12.3)mm vs.4.10(2.15,5.55)mm,P=0.006]、负荷更大[86.83%(80.26%,100.00%)vs.78.46%(72.70%,87.66%),P=0.007]、狭窄程度[86.76%(76.19%,100.00%)vs.75.72%(60.94%,85.84%),P=0.008]、强化程度(P<0.001)及强化指数[(1.19±0.55)vs.(0.58±0.46),P<0.001]均更高,同时其相对平均通过时间(relative mean transit time,rMTT)[(1.19±0.22)vs.(1.05±0.17),P=0.007]、相对流出时间(relative time to drain,rTTD)[(1.52±0.47)vs.(1.19±0.30),P=0.003]、相对剩余函数达峰时间(relative time to the center of the impulse response function,rTmax)[(2.26±1.33)vs.(1.55±0.67),P=0.007]均更大。多因素Logistic回归分析显示:斑块长度(OR=1.17,95%CI:1.001~1.362,P=0.049)、强化程度(OR=5.18,95%CI:1.848~14.522,P=0.002)及rTmax(OR=2.32,95%CI:1.019~5.298,P=0.045)为ACI的独立预测因子。斑块长度、强化程度及rTmax三者联合模展开更多
文摘Objective： To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging （HRMR VWI） for intracranial arterial stenosis. Date Sources： We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging （VWI）, high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. Study Selection： We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. Results： VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies （atherosclerotic or nonatherosclerotic） had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. Conclusions： This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.
文摘目的研究头颈动脉高分辨率磁共振血管壁成像(HR-VWI)对隐匿性卒中病因精准诊断的临床应用价值。方法选择经过临床评估及血管腔评估不能确定病因或不能确定治疗方案,而行HR-VWI的卒中患者共21例进行分析,观察HR-VWI对血管壁病变的诊断能力。结果HR-VWI发现颈动脉蹼2例,在行HR-VWI之前怀疑心源性卒中的头颈动脉夹层4例,成人型烟雾病(MMD)4例,动脉粥样硬化性烟雾综合征(AS-MMS)4例,中枢神经系统血管炎7例(其中原发性中枢神经系统血管炎3例,巨细胞动脉炎2例,系统性红斑狼疮1例,桥本脑病1例),均行HR-VWI后明确病因并确定治疗方案。其中,对比MMD,AS-MMS在HR-VWI中出现偏心性斑块更多、强化更明显,狭窄处外壁面积更大[(0.0925±0.0220)cm2 vs(0.0461±0.0291)cm2],重构指数更高(0.51±0.10 vs 0.36±0.15)。结论HR-VWI在隐匿性卒中病因诊断中具有重要鉴别价值,能表现各类血管壁病变的典型特征,可在血管标准评估及高级评估之后尽早执行。
文摘目的通过应用高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)及CT灌注(computed tomography perfusion,CTP)成像对症状性大脑中动脉(middle cerebral artery,MCA)粥样硬化狭窄患者的斑块特征及血流灌注进行分析,探寻与急性脑梗死(acute cerebral infarction,ACI)相关的高危影像特征。材料与方法回顾性分析64例发病时间小于4周的症状性MCA粥样硬化狭窄患者的HRMR-VWI及CTP影像资料。根据扩散加权成像(diffusion weight imaging,DWI)和临床表现,将患者分为ACI组和短暂性脑缺血发作(transient ischemic attack,TIA)组,分析两组斑块特征、灌注参数及侧支评分的差异,构建多变量Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线、计算曲线下面积(area under the curve,AUC),评估显著变量及其联合模型对ACI预测价值。结果共纳入64例患者。TIA组共25例,女10例,年龄(55.12±11.20)岁。ACI组共39例,女11例,年龄(57.90±9.62)岁。两组间性别(P=0.327)、年龄(P=0.296)差异无统计学意义。与TIA组相比,ACI组的斑块长度更长[6.10(3.20,12.3)mm vs.4.10(2.15,5.55)mm,P=0.006]、负荷更大[86.83%(80.26%,100.00%)vs.78.46%(72.70%,87.66%),P=0.007]、狭窄程度[86.76%(76.19%,100.00%)vs.75.72%(60.94%,85.84%),P=0.008]、强化程度(P<0.001)及强化指数[(1.19±0.55)vs.(0.58±0.46),P<0.001]均更高,同时其相对平均通过时间(relative mean transit time,rMTT)[(1.19±0.22)vs.(1.05±0.17),P=0.007]、相对流出时间(relative time to drain,rTTD)[(1.52±0.47)vs.(1.19±0.30),P=0.003]、相对剩余函数达峰时间(relative time to the center of the impulse response function,rTmax)[(2.26±1.33)vs.(1.55±0.67),P=0.007]均更大。多因素Logistic回归分析显示:斑块长度(OR=1.17,95%CI:1.001~1.362,P=0.049)、强化程度(OR=5.18,95%CI:1.848~14.522,P=0.002)及rTmax(OR=2.32,95%CI:1.019~5.298,P=0.045)为ACI的独立预测因子。斑块长度、强化程度及rTmax三者联合模
