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目的报道运用64层容积CT数字减影血管成像(Volume computed tomography digitalsubtraction angiography,VCTDSA)研究大脑中动脉(Middle Cerebral Artery,MCA)水平段(M1段)走行及其分支解剖和变异。方法前瞻性观测脑血管或头颈血管VCTDSA检查脑底动脉表现无异常者120例,在VR图像上观测MCA-M1段走行及分支类型,测量M1段起始处管径,比较不同侧别、性别管径有无差异。结果120例240侧MCA中,M1段走行分为4型:水平型40.41%(97/240侧),上斜型14.58%(35/240侧),下斜型7.92%(19/240侧),波浪型37.08%(89/240侧);M1段主干分3型:单干型7.91%(19/240侧)、双干型88.75%(213/240侧)、三干型3.33%(8/240侧);M1起始处管径左侧:(1.98±0.44)mm,右侧:(2.05±0.46)mm;男性:(2.01±0.39)mm,女性:(2.03±0.41)mm;管径不存在侧别和性别的差异(P=0.062、0.792)。M1段分支类型除TanrioverN划分八种类型外,另还有IIB、IIC、IVC亚型共3种亚型。发育变异包括窗式变异2例、副大脑中动脉1例、早分叉5例。结论VCTDSA能清楚地显示MCA-M1段血管的解剖和变异,管径正常值可作为临床诊断脑血管疾病的参考。
Objective To investigate the migration of the middle cerebral artery (MCA) (M1 segment) and its branch anatomy and variation using volume computed tomography digitalsubtraction angiography (VCTDSA). Methods A prospective observational study of cerebrovascular or head-and-neck vascular VCTDSA showed no abnormalities in the cerebral arteries. 120 cases were observed on the VR images and the MCA-M1 segments were observed. The diameter of the M1 segment at the beginning was measured. Is there any difference in diameter? Results The M1 segments of 120 MCA patients were classified into 4 types: horizontal 40.41% (97/240), obliquely 14.58% (35/240), obliquely 7.92% (19/240) , 37.08% (89/240 side) of the wave type; M1 segment trunk type 3: 7.91% (19/240 side), 88.75% (213/240 side), 3.33% (2.01 ± 0.39) mm for female and (2.03 ± 0.41) mm for female; (2.03 ± 0.41) mm for male; There were no gender differences (P = 0.062, 0.792). In addition to TanrioverN divided into eight types, there are three subtypes of IIB, IIC and IVC in M1 segment. Developmental changes include window-type mutation in 2 cases, 1 case of middle cerebral artery, early bifurcation in 5 cases. Conclusions VCTDSA can clearly show the anatomy and variation of blood vessels in MCA-M1 segment. The normal diameter can be used as a reference for the clinical diagnosis of cerebrovascular diseases.