Imai Masaaki, Shimoda Masami, Oda Shinri, Hoshikawa Kaori, Osada Takahiro, Aoki Rie, Sunaga Azusa
Department of Neurosurgery, Tokai University Hachioji Hospital, Ishikawa Machi, Hachioji, Tokyo, Japan.
Surg Neurol Int. 2021 Nov 16;12:558. doi: 10.25259/SNI_1023_2021. eCollection 2021.
This study investigated hyperintense vessel signs (HVS) on fluid-attenuated inversion recovery imaging in the P1-2 portions of posterior cerebral arteries (PCAs) as a "hyperintense PCA sign" and HVS of cortical arteries. We retrospectively examined whether these signs would be useful in diagnosing reversible cerebral vasoconstriction syndrome (RCVS) in the acute phase.
Eighty patients with RCVS who underwent initial magnetic resonance imaging (MRI) within 7 days of onset were included in this study. HVS and related clinical factors were examined.
On initial MRI of RCVS patients, hyperintense PCA sign and HVS of cortical arteries were seen in 21 cases (26%) and 38 cases (48%), respectively. In patients showing hyperintense PCA sign, vasoconstriction of the A2-3 portion was a significant clinical factor. Conversely, vasoconstriction of the M1 and P1 portions and the presence of white matter hyperintensity on initial and chronic-stage MRI were significantly associated with the presence of HVS in cortical arteries.
Because rich collateral flow exists around PCAs, the frequency of hyperintense PCA sign is not high. However, hyperintense PCA sign findings in patients with suspected RCVS offer credible evidence of extreme flow decreases due to vasoconstriction in peripheral PCAs and other arteries associated with the collateral circulation of PCAs. Conversely, HVS in cortical arteries tend to reflect slow antegrade circulation due to vasoconstriction of peripheral vessel and major trunks. Both signs appear useful for auxiliary diagnosis of acute-phase RCVS.
本研究调查了大脑后动脉（PCA）P1-2段液体衰减反转恢复成像上的高信号血管征（HVS）作为“PCA高信号征”以及皮质动脉的HVS。我们回顾性研究了这些征象在急性期可逆性脑血管收缩综合征（RCVS）诊断中是否有用。
本研究纳入了80例发病7天内接受初次磁共振成像（MRI）的RCVS患者。检查了HVS及相关临床因素。
在RCVS患者的初次MRI上，分别有21例（26%）出现PCA高信号征，38例（48%）出现皮质动脉HVS。在出现PCA高信号征的患者中，A2-3段血管收缩是一个显著的临床因素。相反，M1和P1段血管收缩以及初次和慢性期MRI上白质高信号的存在与皮质动脉HVS的存在显著相关。
由于PCA周围存在丰富的侧支循环，PCA高信号征的出现频率不高。然而，疑似RCVS患者中出现PCA高信号征的表现为PCA外周及与PCA侧支循环相关的其他动脉因血管收缩导致血流极度减少提供了可靠证据。相反，皮质动脉的HVS往往反映了外周血管和主要血管干血管收缩导致的顺行血流缓慢。这两种征象似乎都有助于急性期RCVS的辅助诊断。
