Nassenstein I, Krämer S C, Niederstadt T, Stehling C, Dittrich R, Kuhlenbäumer G, Ringelstein E B, Heindel W, Bachmann R
Leibniz-Institut für Arteriosklerose-Forschung, Westfälische Wilhelms-Universität Münster.
Rofo. 2005 Nov;177(11):1532-9. doi: 10.1055/s-2005-858671.
Aim of this prospective study was to investigate the incidence of spontaneous cervical artery dissection (sCAD) and cerebral ischemia in patients with suspected sCAD by using a combined head-neck MR-imaging protocol.
51 consecutive patients (24 m, 27 f, mean age 39.5 years, range 18 - 55 yrs) admitted to our stroke unit with suspected sCAD according to clinical criteria and age < 55 years underwent a combined head and neck MR examination within 24 hours of admission (Gyroscan Intera 1.5 T, Philips). Head MRI included ax FLAIR, ax T (1), ax DWI and TOF angiography (imaging time 12 min). Neck MRI consisted of ax T1w-TSE, T2w-TSE, contrast enhanced T1w-TSE and CE-MRA (imaging time 17 min). Three radiologists assessed both studies in consensus with regard to the presence of sCAD and acute ischemia.
One patient had to be excluded because of motion artefacts. In 17 of 50 patients sCAD was diagnosed, and in 20 of 50 patients cerebral ischemia. In 5 patients cerebral ischemia was caused by sCAD.
The proposed combined MR protocol allows imaging work-up of patients with suspected sCAD within approximately 30 min, resulting in conclusive information about the status of the extracranial vasculature and the presence of ischemia. The high incidence of patients with definite sCAD and the low incidence of cerebral ischemia indicates the necessity of an early definite diagnosis in order to start timely anticoagulation to prevent development of stroke.
本前瞻性研究旨在通过使用联合头颈部磁共振成像方案,调查疑似自发性颈动脉夹层(sCAD)患者的sCAD发病率和脑缺血情况。
51例连续患者(24例男性,27例女性,平均年龄39.5岁,范围18 - 55岁)因符合临床标准且年龄<55岁,以疑似sCAD入住我们的卒中单元,在入院24小时内接受了联合头颈部磁共振检查(飞利浦Gyroscan Intera 1.5T)。头部磁共振成像包括轴位液体衰减反转恢复序列(FLAIR)、轴位T1加权像(T1)、轴位扩散加权成像(DWI)和时间飞跃血管造影(成像时间12分钟)。颈部磁共振成像包括轴位T1加权快速自旋回波序列(T1w-TSE)、T2加权快速自旋回波序列(T2w-TSE)、对比增强T1加权快速自旋回波序列和对比增强磁共振血管造影(CE-MRA,成像时间17分钟)。三位放射科医生就sCAD和急性缺血的存在情况达成共识,对两项检查进行评估。
1例患者因运动伪影被排除。50例患者中,17例诊断为sCAD,20例诊断为脑缺血。5例患者的脑缺血由sCAD引起。
所提议的联合磁共振方案可在约30分钟内对疑似sCAD患者进行成像检查,从而获得关于颅外血管系统状况和缺血存在情况的确切信息。确诊sCAD患者的高发病率和脑缺血的低发病率表明,为了及时开始抗凝治疗以预防中风的发生,早期明确诊断很有必要。