颈动脉狭窄的检测和诊断.ppt

**Ajnr200021071199Presleukoencephalopathyandwethuspreferanewname:posteriorreversibleencephalopathysyndrome(PRES).CSA:CSA,cyclosporinAneurotoxicity;FIG4.Case11:48-year-oldmanbeingtreatedwithCSAwhopresentedwithgeneralizedseizuresshortlybeforeimaging.AandB,Protondensity–weighted(A)andaxialT2-weighted(B)sectionsrevealanonspecificpunctatewhitematterhyperintensity(arrow)intheleftparietallobe.C,Correspondingturbo-FLAIRimageshowsbiparietalincreasedsignalwithinthecortex(whitearrows)andsubcorticalwhitematter(blackarrow),representingedemaandsuggestingtheradiologicdiagnosisofPRES.DandE,Adjacentprotondensity–weighted(D)andT2-weighted(E)images,onelevelsuperiorly,showincreasedcortical(whitearrows)andsubcorticalwhitemattersignalduetoedema.F,Turbo-FLAIRimageatsamelevelagainrevealsthecortical-basedhyperintensitiesthataredifficulttoappreciateonstandarddual-echosequences,owingtotheadjacentbrightCSF.FLAIRunmasksthisabnormalitybysuppressingCSFsignal.ThiscasewasassignedamoderateseverityscoreonthebasisoftheFLAIRimagingfindings,althoughonthebasisofprotondensity–orT2-weightedimagesitwouldhavebeenconsideredmild.**常规造影6小时后检查，70岁患者怀疑颈动脉狭窄，术中有暂时性意识障碍，术后无缺损**Stroke.2001;32:1323-1329.A:LargelesioninvolvingthecortexTerritorialinfarction可能是ICA或MCA的闭塞，没有侧支循环B:Subcorticallesionwithorwithoutadditionalsmallerlesion(s);Subcorticalinfarction可能是穿通支闭塞或MCA主干闭塞，但有皮层的侧支C:Severaldisseminatedsmalllesions，小血管被栓子或碎裂的血栓栓塞D:Smalllesionsinhemodynamicriskzones;Borderzoneinfarction:可能是大血管闭塞或严重狭窄导致的主要血管交界区及皮层和深部穿通血管交界区梗死**此组检查的意义在于在梗死前确定脑组织缺血，缺血程度，治疗后血流是否改善，治疗效果。**GillardJH,HardinghamCR,KirkpatrickPJ,AntounNM,FreerCE,GriffithsPD.EvaluationofcarotidendarterectomywithsequentialMRperfusionimaging:apreliminaryreport.AJNRAmJNeuroradiol1998;19(9):1747-1752.F