摘要目的 探讨烟雾病患者自然病程中大脑中动脉始端血管壁MRI表现及其变化.方法 前瞻性纳入郑州大学第一附属医院神经介入科自2014年1月至2015年12月收治的19例烟雾病患者,随访观察每例患者单侧大脑中动脉始端血管壁MRI表现及其临床症状. 结果 收治时,19例患者中铃木分期Ⅱ期2例,Ⅲ期9例,Ⅳ期8例;血管最大横截面积为(5.7±1.4) mm2,血管壁最大厚度为(0.9±0.2)mm;血管壁无强化15例,轻度强化2例,明显强化2例;血管壁向心性增厚17例,偏心性增厚2例;2例Ⅲ期患者呈向心性增厚、血管壁轻度强化,2例Ⅲ期患者呈向心性增厚、血管壁显著强化,1例Ⅱ期患者及1例Ⅳ期患者呈偏心性增厚、血管壁无强化,1例Ⅱ期患者、5例Ⅲ期患者及7例Ⅳ例患者呈向心性增厚、血管壁无强化.平均随访38.7个月后,19例患者的血管最大横截面积为(5.5±1.2) mm2,血管壁最大厚度为(1.0±0.3) mm,与之前相比差异均无统计学意义(P＞0.05);2例Ⅱ期患者进展成Ⅲ期(血管壁分别从无强化发展成显著强化或轻度强化),余患者的铃木分期、血管壁强化程度及增厚方式未见明显变化.6例患者在随访期间脑缺血症状再次发作,其中血管壁强化者4例,无强化者2例. 结论 Ⅱ～Ⅳ期烟雾病患者的大脑中动脉始端多呈向心性增厚、血管壁无强化.烟雾病进展缓慢,少数患者的血管壁可从无强化发展到强化,且血管壁强化者脑缺血症状再次发作的可能性更高.

abstractsObjective To investigate the MR imaging features and changes of arterial walls at the beginning of the middle cerebral artery in patients with moyamoya disease during the natural course.Methods Nineteen patients with moyamoya disease,admitted to our hospital from January 2014 to December 2015,were chosen prospectively in the study.The MR imaging manifestations and clinical symptoms of the initial vascular walls of the unilateral middle cerebral artery in each patient were observed.Results Two patients were classified as Suzuki grading Ⅱ,9 were classified as Suzuki grading Ⅲ,and 8 were classified as Suzuki grading Ⅳ.The maximum cross-sectional area of patients with moyamoya disease was (5.7±1.4) mm2,and the maximum thickness was (0.9±0.2) mm;15 patients showed wall non-enhancement,two showed wall slight enhancement,and two showed wall obvious enhancement.Concentric thickening was noted in 17 patients and eccentric thickening in two.Two patients with Suzuki grading Ⅲ presented concentric thickening and slight enhancement;two patients with Suzuki grading Ⅲ presented concentric thickening and obvious enhancement;one patient with Suzuki grading Ⅱ and one with Suzuki grading Ⅳ presented eccentric thickening and non-enhancement;one patient with Suzuki grading Ⅱ,5 with Suzuki grading Ⅲ and 7 with Suzuki grading Ⅳ presented concentric thickening and non-enhancement.After the follow up for a median time of 38.7 months,the maximum cross-sectional area was (5.5±1.2) mm2 and the maximum thickness was (1.0±0.3) mm,which showed no significant differences as compared with those at admission (P＞0.05).Two patients with Suzuki grading Ⅱ progressed to Suzuki grading Ⅲ (the vessel wall developed from non-enhancement to slight or obvious enhancement).No obvious differences in Suzuki grading,enhancement or thickening styles were noted in the other patients during the follow up.Six patients had recurrent cerebral ischemia during follow-up,4 were with wall enhancement,and two were with wall non-enhancement.Conclusions Patients with moyamoya disease at Suzuki grading Ⅱ-Ⅳ commonly present concentric thickening without enhancement.Moyamoya disease progresses slowly,a few patients with moyamoya disease may present enhancement when it is in progress,and patients with wall enhancement are more likely to have recurrent attack of cerebral ischemia.