Arai M, Higuchi A, Umekawa J, Mochimatsu Y, Itoh K
Department of Otolaryngology, Yokohama Red Cross Hospital.
Nihon Jibiinkoka Gakkai Kaiho. 1999 Jul;102(7):925-31. doi: 10.3950/jibiinkoka.102.925.
Major causes of vertigo in patients who attend Otolaryngology clinics are peripheral vestibular disorders (PVD) and vertebrobasilar insufficiency (VBI). The purpose of this study was to see whether MRA findings can distinguish VBI from PVD to evaluate the efficiency of MRA in the diagnosis of vertigo. A total of 185 vertigo patients were examined by MRA with the 3D-Phase Contrast method. Three kinds of abnormalities of vessels, that is, (a) disappearance, (b) meandering, and (c) stoppage were found in MRA imaging. Therefore, we classified the MRA patterns into four types with two subtypes: type I; normal, type II-R; right hypoform of the vertebral artery, II-L; left hypoform of the vertebral artery, III; meandering form of the vertebrobasilar artery, IV-1; stoppage form of the basilar artery, IV-2; hypoform of the bilateral vertebral and basilar arteries. Diagnosis of the MRA patterns in each patient was camed out by a radiologist and neurosurgeon with the cooperation of an otolaryngologist. In 185 vertigo patients, 139 patients were clinically diagnosed as having PVD, 41 patients as having VBI, and 5 patients as having cerebellar and brainstem infarctions. The numbers of patients in MRA patterns I, II-R, II-L, III and IV were 140, 17, 12, 8, and 8 cases, respectively. The total number of VBI patients who demonstrated type III or IV patterns in MRA was significantly higher than that of type I, II-R and II-L (P < 0.005). All of the 8 cases with cerebellar and brainstem infarction belonged to type IV. Cerebral angiography was performed in nine cases with type II-R, II-L, III or IV-1, and the number of patients in each group was 3, 3, 1 and 2 cases, respectively. All of the type II-R and II-L cases revealed hypoform of the vertebral artery. The appearance of type III was restricted to type III's view was only meandering and type IV-1 showed severe stenotic changes in the union area. These data show that MRA findings in the diagnosis of vertigo patients are very effective in distinguishing VBI and cerebellar and brainstem infarction from PVD and that some pattern of MRA may correspond to atherosclerosis of the vertebrobasilar artery. We think MRA examination of vertigo patients is useful not only to assist in the diagnosis of the etiology but also to predict the stage of atherosclerosis in each patient.
在耳鼻喉科门诊就诊的眩晕患者中，主要病因是外周前庭疾病（PVD）和椎基底动脉供血不足（VBI）。本研究的目的是观察磁共振血管造影（MRA）结果能否区分VBI和PVD，以评估MRA在眩晕诊断中的效率。采用三维相位对比法对185例眩晕患者进行了MRA检查。在MRA成像中发现了三种血管异常，即（a）消失、（b）迂曲和（c）阻塞。因此，我们将MRA模式分为四种类型及两个亚型：I型，正常；II-R型，椎动脉右侧形态异常；II-L型，椎动脉左侧形态异常；III型，椎基底动脉迂曲型；IV-1型，基底动脉阻塞型；IV-2型，双侧椎动脉和基底动脉形态异常。由放射科医生和神经外科医生在耳鼻喉科医生的配合下对每位患者的MRA模式进行诊断。在185例眩晕患者中，139例临床诊断为PVD，41例为VBI，5例为小脑和脑干梗死。MRA模式I、II-R、II-L、III和IV的患者数量分别为140、17、12、8和8例。MRA显示III型或IV型模式的VBI患者总数显著高于I型、II-R型和II-L型（P<0.005）。所有8例小脑和脑干梗死患者均属于IV型。对9例II-R型、II-L型、III型或IV-1型患者进行了脑血管造影，每组患者数量分别为3、3、1和2例。所有II-R型和II-L型病例均显示椎动脉形态异常。III型的表现仅限于III型所见，仅为迂曲，IV-1型在汇合区显示严重狭窄改变。这些数据表明，MRA结果在眩晕患者的诊断中对于区分VBI以及小脑和脑干梗死与PVD非常有效，并且MRA的某些模式可能与椎基底动脉粥样硬化相对应。我们认为对眩晕患者进行MRA检查不仅有助于病因诊断，还能预测每位患者的动脉粥样硬化阶段。
