顱內(nèi)動(dòng)脈斑塊高分辨成像

1、,高分辨核磁 李明耀,,各個(gè)序列,,圖像處理軟件,,歷史沿革,,,,1995年,,最初,,髂動(dòng)脈粥樣硬化斑塊,,第一項(xiàng)關(guān)于顱內(nèi)血管壁成像的研究進(jìn)展,1990年,,Edelman等分析了頸動(dòng)脈粥樣硬化性疾病的黑血和亮血成像技術(shù)斑塊組成特點(diǎn)及MRI信號(hào)表現(xiàn)，對(duì)動(dòng)脈粥樣硬化的評(píng)價(jià)不再僅局限于動(dòng)脈狹窄。,,2003年,Naghavi等

2、介紹了主要針對(duì)頸動(dòng)脈不穩(wěn)定斑塊的模型，證明特定的斑塊成分可以導(dǎo)致患者的臨床癥狀進(jìn)展，結(jié)局表現(xiàn)為血栓形成和栓塞,,2009年,,《neurology》 HRMRI可以區(qū)分顱內(nèi)動(dòng)脈不同的病變,磁共振斑塊成像在中國,成像技術(shù),“亮血”技術(shù),用3D時(shí)間飛躍法成像 (three dimention time of flight,3D-TOF)優(yōu)點(diǎn)：采集時(shí)間短,成像技術(shù),“黑血”技術(shù)：通過各種方法抑制流動(dòng)血液信號(hào)，使管腔內(nèi)血液流動(dòng)信號(hào)消失，以

3、便更好的襯托出管壁軟組織（動(dòng)脈粥樣硬化斑塊）的信號(hào)，該技術(shù)是斑塊成像技術(shù)的核心。,T1序列（T1-weighted imaging，T1WI）、 T2序列（T 2-weighted imaging，T2WI） 質(zhì)子序列（proton density weighted imaging，PDWI） 磁化準(zhǔn)備快速梯度回波序列（magnetization prepared rapid gradientecho，MP-RAGE）

4、T1強(qiáng)化序列（T1 contrast enhanced weighted imaging，T1+C）,,,顱內(nèi)動(dòng)脈粥樣硬化,,動(dòng)脈夾層,,Moyamoya病,,動(dòng)脈瘤,,腦小血管病,,靜脈系統(tǒng)血栓,應(yīng)用目的,判定缺血性卒中發(fā)病機(jī)制,應(yīng)用目的,除外非動(dòng)脈粥樣硬化性狹窄,應(yīng)用目的,分析斑塊特點(diǎn)（穩(wěn)定 OR 不穩(wěn)定） 斑塊負(fù)荷 斑塊體積 斑塊出血

5、 斑塊鈣化 斑塊強(qiáng)化 斑塊分布（腹/背/上/下） 血管壁重構(gòu)模式,易損斑塊的四大病理特征,與組織病理學(xué)切片的交叉驗(yàn)證,,利用多對(duì)比度磁共振信號(hào)特征可以區(qū)分斑塊當(dāng)中不同的成分,LRNC:大的富含脂質(zhì)的壞死核心,主要序列及優(yōu)勢(shì),斑塊出血：斑塊不穩(wěn)定的標(biāo)志之一,A 72-year-old woman with basilar artery pla

6、que and acute pontine infarction,,斑塊強(qiáng)化:與卒中復(fù)發(fā)相關(guān),International Journal of Stroke 2016, Vol. 11(2) 171–179,,Representative brain MR finding of a stroke patient with intracranial atherosclerosis and recurrence. The patient w

7、as admitted with right side weakness. Initial diffusion MR imaging (MRI) shows left internal capsular infarction (a, arrowhead) with left middle cerebral artery stenosis on time-of-flight MR angiography (b, arrow). High

8、 resolution MRI shows eccentric plaque with enhancement from T1 weighted gadolinium enhancement protocol (c, d, arrows) and heterogeneous signal from T2 weighted image (e, arrow). Five days after admission his weakness

9、deteriorated with newly developed motor aphasia, and diffusion MRI disclosed additional multiple infarctions involving left middle cerebral artery territory (f, arrowhead),,Another patient admitted with right side weakn

10、ess and initial brain imaging disclosed left pontine infarction from diffusion MR (g, arrowhead) and basilar artery stenosis(h, arrow). The plaque from high resolution MRI shows enhancing lesion (i, j, arrows) with heter

11、ogeneous signal (k, arrow). Two months after discharge she was admitted again with right side hypesthesia. Diffusion MRI shows another left pontine infarction(l, arrowhead).,斑塊重構(gòu)（陽性重構(gòu)/陰性重構(gòu)）,RI ＞1.05 was defined as positi

12、ve remodeling (PR) and RI＜1.05 as non-PR. VA (MLN) RI= VA(REF)陽性重構(gòu)血管較之陰性重構(gòu)血管更可能發(fā)生血管事件癥狀性狹窄處血管陽性重構(gòu)明顯多于陰性重構(gòu)陽性重構(gòu)較陰性重構(gòu)更常見微栓子信號(hào),,斑塊分布：影響復(fù)發(fā)風(fēng)險(xiǎn)及梗死類型,癥狀性大腦中動(dòng)脈狹窄，斑塊更容易出現(xiàn)在上象限癥狀性基底動(dòng)脈狹窄，斑塊更容易出現(xiàn)在腹側(cè)