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目的探讨烟雾病的影像学诊断特征。方法回顾性分析40例烟雾病患者的影像学表现,40例均行头颅CT、数字减影血管造影(DSA)检查,16例行磁共振成像(MRI)检查,22例行磁共振血管造影(MRA)检查。结果头颅CT显示脑出血(36/40),以脑室出血多见;脑梗死(4/40)。MRI显示脑出血(12/16),其中8例可检出陈旧性的腔隙性梗死灶;脑梗死(4/16);颈内动脉末端(TICA)和(或)大脑前动脉(ACA)、大脑中动脉(MCA)血管流空影纤细或缺失(12/16);烟雾血管(10/16)。MRA显示双侧TICA和(或)ACA、MCA缺失或纤细(18/22);单侧TICA和(或)ACA、MCA缺失或纤细(4/22);大脑后动脉(PCA)缺失或纤细(6/22);烟雾血管(12/22)。DSA 40例均显示双侧TICA和(或)ACA、MCA不同程度狭窄或闭塞,累及PCA狭窄或闭塞12例;烟雾血管(40/40);6例可见动脉瘤。结论烟雾病的头颅CT平扫无特异性;磁共振诊断因其无创,且MRI可以更好的显示脑内继发改变,而MRA对大血管的评价与脑血管造影结果有很好的相关性,可作为首选检查方法;DSA对血管病变范围、病变程度及烟雾血管的显示优于MRA,可显示继发动脉瘤,目前仍是烟雾病诊断的金标准。
Objective To explore the diagnostic features of moyamoya disease. Methods The imaging findings of 40 patients with moyamoya disease were retrospectively analyzed. Forty patients underwent cranial CT, DSA, 16 MRI and 22 magnetic resonance angiography MRA) examination. Results Cerebral CT showed cerebral hemorrhage (36/40), more common in ventricular hemorrhage; cerebral infarction (4/40). MRI showed cerebral hemorrhage (12/16), of which 8 cases could detect old lacunar infarcts; cerebral infarction (4/16); end of internal carotid artery (TICA) and / or anterior cerebral artery (ACA) , Middle cerebral artery (MCA) vascular thinning or missing vascular thin film (12/16); smoke and blood vessels (10/16). MRA showed bilateral TICA and / or ACA, MCA deletion or stenosis (18/22); unilateral TICA and / or ACA, MCA deletion or slender (4/22); loss of posterior cerebral artery (PCA) or slender 6/22); smoke and blood vessels (12/22). DSA 40 cases showed bilateral TICA and / or ACA, MCA to varying degrees of stenosis or occlusion involving 12 cases of PCA stenosis or occlusion; smoke and blood vessels (40/40); 6 cases of visible aneurysms. Conclusion CT scan of moyamoya disease is nonspecific. MR diagnosis is noninvasive, and MRI can better show secondary changes in the brain. MRA has a good correlation with the evaluation of macrovascular and cerebral angiography , Can be used as the preferred method of examination; DSA for vascular lesions range, degree of lesion and smoke and blood vessels better than MRA, can show secondary aneurysm, is still the gold standard for the diagnosis of moyamoya disease.