Zhang Meng, Ye Gengfan, Liu Yuandong, Wang Qian, Li Shuying, Wang Yunyan
Department of Neurosurgery, Hospital of Shandong Traditional Chinese Medicine University.
Department of Neurosurgery, QiLu Hospital, Shandong University, Jinan.
Medicine (Baltimore). 2019 Apr;98(14):e14857. doi: 10.1097/MD.0000000000014857.
Vertebrobasilar artery dissecting aneurysm (VBA-DA) is associated with serious complications and poor prognosis in patients. High-resolution magnetic resonance imaging (HR-MRI) is a noninvasive method for the diagnosis of VBA-DA.VBA-DAs were classified according to the feature of HR-MRI in combination with digital subtraction angiography (DSA), and the clinical outcomes of different types of VBA-DAs were analyzed. Thirty-nine patients with 42 VBA-DAs were included and underwent HR-MRI, including three-dimensional T1 weighted image, three-dimensional T2 weighted image (3D-T2WI), three-dimensional time of flight MRA (3D-TOF-MRA), and three-dimensional fast imaging employing steady state acquisition (3D-FIESTA), and hematoma and flaps were compared. The follow-up was 3 to 25 months. The VBA-DAs were classified based on the images of HR-MRI and DSA, and the prognosis was analyzed.VBA-DAs more frequently occurred on the vertebral artery, especially on the dominant vertebral artery. 3D-TOF-MRA showed high signal from hematoma, and 3D-FIESTA showed high signal from flaps. Based on HR-MRI images in combination with DSA, VBA-DAs were classified into 4 types: classical, stenosis, spiral, and hemorrhagic. The patients with the classical VBA-DAs had a higher improvement rate and a lower exacerbation rate. The patients with spiral and hemorrhagic VBA-DAs had poor clinical outcomes. The patients with stenosis VBA-DAs had poorer clinical outcomes than classical types and better clinical outcomes than spiral and hemorrhagic types.The detection of intramural hematoma and dissection flap using HR-MRI provides basic information for the diagnosis of VBA-DA. Individualized therapeutic strategies can be designed for the treatment of VBA-DAs with different features of DSA and HR-MRI.
椎动脉夹层动脉瘤（VBA - DA）与患者的严重并发症及不良预后相关。高分辨率磁共振成像（HR - MRI）是诊断VBA - DA的一种非侵入性方法。根据HR - MRI特征结合数字减影血管造影（DSA）对VBA - DA进行分类，并分析不同类型VBA - DA的临床结局。纳入39例患有42个VBA - DA的患者并接受HR - MRI检查，包括三维T1加权像、三维T2加权像（3D - T2WI）、三维时间飞跃磁共振血管造影（3D - TOF - MRA）以及三维稳态采集快速成像（3D - FIESTA），并比较血肿和内膜瓣情况。随访时间为3至25个月。根据HR - MRI和DSA图像对VBA - DA进行分类，并分析预后。VBA - DA更常发生于椎动脉，尤其是优势椎动脉。3D - TOF - MRA显示血肿呈高信号，3D - FIESTA显示内膜瓣呈高信号。基于HR - MRI图像结合DSA，VBA - DA分为4种类型：经典型、狭窄型、螺旋型和出血型。经典型VBA - DA患者的改善率较高，恶化率较低。螺旋型和出血型VBA - DA患者的临床结局较差。狭窄型VBA - DA患者的临床结局比经典型差，但比螺旋型和出血型好。利用HR - MRI检测壁内血肿和夹层瓣可为VBA - DA的诊断提供基础信息。可针对具有不同DSA和HR - MRI特征的VBA - DA设计个体化治疗策略。
