Fiebach J, Brandt T, Knauth M, Jansen O
Abteilung Neuroradiologie, Neurologischen Klinik, Universitätsklinikum Heidelberg.
Rofo. 1999 Oct;171(4):290-3. doi: 10.1055/s-1999-257.
Comparison of different MR-examination techniques for the diagnosis of acute spontaneous internal carotid artery dissection.
13 patients (age range 23-59 years) with symptomatic spontaneous dissection of the internal carotid artery were examined. The MRI protocol contained a transverse spin echo sequence, a time-of-flight MR-angiography and a coronal fat suppressed T1-weighted sequence. The earliest examination was performed three days after symptom onset. Follow-up extended up to 30 months. We compared the three different sequences to find out the one that demonstrated the hematoma best.
MR-angiography shows a narrowing of the vessel diameter in early examinations. During the subacute stage methemoglobin can obscure this finding. From the third day on fat suppressed T1-weighted images showed a hyperintense hematoma that strongly contrasted to the surrounding fatty tissue. Fat suppressed images showed a hyperintense hematoma up to 10 months after symptom onset while MRA and spin echo sequences did not.
Fat suppressed T1-weighted images are superior in showing vessel wall hematoma and should thus be used in the standard MR-protocol for spontaneous internal carotid artery dissection.
比较不同磁共振成像（MR）检查技术对急性自发性颈内动脉夹层的诊断价值。
对13例有症状的自发性颈内动脉夹层患者（年龄范围23 - 59岁）进行检查。MRI检查方案包括横断位自旋回波序列、时间飞跃法磁共振血管造影（TOF-MRA）及冠状位脂肪抑制T1加权序列。最早在症状出现后3天进行检查，随访长达30个月。我们比较这三种不同序列，以找出显示血肿最佳的序列。
在早期检查中，磁共振血管造影显示血管直径变窄。在亚急性期，高铁血红蛋白可能会掩盖这一表现。从第3天起，脂肪抑制T1加权图像显示高强度血肿，与周围脂肪组织形成强烈对比。脂肪抑制图像在症状出现后长达10个月均显示高强度血肿，而磁共振血管造影和自旋回波序列则未显示。
脂肪抑制T1加权图像在显示血管壁血肿方面更具优势，因此应纳入自发性颈内动脉夹层的标准MR检查方案。
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