高分辨率磁共振血管壁成像诊断颈内动脉肌纤维发育不良合并瘤样扩张一例

High-resolution magnetic resonance vessel wall imaging in the diagnosis of fibromuscular dysplasia of the internal carotid artery with aneurysmal ectasia:One case report

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摘要本文为回顾性研究,经过深圳市宝安区人民医院伦理委员会批准,免除受试者知情同意,批准文号:BYL20220203.患者男,39岁,因发现颈部包块3个月就诊.体格检查:右侧颈部可触及一个搏动性包块,四肢肌力正常.实验室检查无异常.既往无高血压、糖尿病及心脏病病史.颈动脉彩超检查提示右侧颈内动脉颈段巨大动脉瘤.头颅MRI平扫诊断:双侧额叶亚急性期腔隙性脑梗死(图1A).头颅磁共振灌注加权成像(perfusion-weighted imaging,PWI)诊断:右侧大脑半球低灌注改变(图1B、1C).头颈部CT血管成像(computed tomography angiography,CTA)诊断:右侧颈内动脉颈段巨大动脉瘤(图1D).颈部三维磁共振血管成像容积重建(three-dimensional magnetic resonance angiograpgy,3D-MRA)及高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HR-VWI)示右侧颈内动脉C1段走形迂曲,管腔呈瘤样扩张改变,瘤壁呈向心性均匀增厚,呈T1及T2稍高信号,增强扫描呈明显强化(图1E～1H) ,最终诊断:右侧颈内动脉颈段肌纤维发育不良(fibromuscular dysplasia ,FMD)合并瘤样扩张.随后患者进行头颈部数字减影血管造影(digital subtraction angiography,DSA)检查示:右侧颈内动脉颈段串联巨大动脉瘤,瘤内可见血液湍流,载瘤动脉迂曲,颅内血流缓慢,压迫右侧颈总动脉,行左侧颈内动脉造影可见前交通动脉开放.