Joint Application Of MRA,MRS,DTI And Xe-CT In The Diagnosis And Treatment Of Cerebrovascular Stenosis: A Pilot Study

ATCI (atherosclerotic thrombotic cerebral infarction) is the most common type of ischemic strokes, and is also the key point of the study of ischemic strokes. IAS (intracranial artery stenosis) is the pathologic basis of ischemic stroke. There usually exists IAS before strokes happen in ATCI patients, the risks factors of which include heredity, age, gender, race, diabetes, smoking, obesity, hyper-homocysteinemia, etc. It is pivotal to determine and deal with the risk factors of IAS in the prevention of ATCI. While most such patients seen in the clinic have symptoms of chronic cerebrovascular insufficiency or TIA caused by IAS. In terms of this fact, it is intractable for clinical neurologists to diagnose and treat IASs so as to effectively prevent strokes. TIA (transient ischemic attack) is an emergency of neurology departments, one third untreated cases of which are to develop into cerebral infarction, one third may have repeated attacks, and one third may heal. Thus TIA should be paid extra attention to and treated timely in order to prevent cerebral infarction. Presently, the main methods to examine IAS are TCD, MRA, CTA, DSA, Xe-CT, PWI, CTP, PET, etc. All of them have their own advantages and disadvantages, and the combined use of them can increase the accuracy of IAS diagnosis. In terms of IAS treatment, drug therapeutics, stent-assistant angioplasty and carotid endarterectomy are the main methods, among which stent-assistant angioplasty is the acknowledged one to treat IAS and prevent strokes effectively. However there are strict indications to observe of stent-assistant angioplasty in preventing progessive artery stenosis and stroke occurrence.In this research, American Nicolet TC8080 TCD machine, German Siemens MAGNETOM Avanto 1.5T MR machine, and American Diversified Diagnostic Products Xe-CT CBF system were used in combination to examine IASs ininpatients and outpatients with symptoms of TIA, by means of TCD, MRI plain scan, MRI-FLAIR, MRS, DTI and Xe-CT, after which the (Cho+Cr) /NAA values, FA values and CBF values of the basal ganglion regions were measured. The data were analysed with statistical methods.The results are as follows: All 6 patients proved to have MCA stenosis by MRA, and the unilateral stenosis in one case and the bilateral stenosis in the other 5 can explain the symptoms respectively; All patients took Xe-CT examinations, and their average CBF values in the basal ganglion regions of the two sides were not the same, with the maximum difference of 12.2ml/ (100g·min), and the minimum of 1.5ml/ (100g·min). In 5 out of the 6 cases, the average CBF values are statistically different in the basal ganglion regions of the two sides, and accordingly, the FA values of both sides are significantly different; In the rest one case, there shows no significant differences in both CBF and FA values. 5 cases took two-dimensional MRS examination, and the (Cho+Cr) /NAA values in the basal ganglion regions of the two sides were not the same. 3 out of them showed statistical difference in the basal ganglion regions of the two sides, while the other 2 showed not.From the results above and the discussion of IAS evaluation and treatment, we draw such conclusions: The innovation of this research is the first time to use MRA, MRS, DTI, and Xe-CT techniques to study IAS patients with clinical manifestations of internal carotid artery TIA, thus to mean to search the transverse links of these imaging techniques; There may be correlations between CBF and FA values in cerebral globes with IAS; TIA is an emergency of neurology departments, which should be paid extra attention to and treated timely in order to prevent cerebral infarction. Especially for those patients with stenosis of main arteries, early treatment of vascular stenosis may effectively prevent severe cerebral infactions; Bilateral internal carotid artery TIA should be taken intoaccount in addition to periodic paralysis and vertebral basilar TIA in patients with outbreaks of bilateral paralysis; Before DSA examination and stent-assistant angioplasty, sufficient evaluation should be made and strict indications should be observed. Further we can find a data processing media, and increase the sample size and experiment parameters, in hope of unifying the examinations of cerebral biochemistry, CBF and vascular morphologic changes, and simplifying the IAS examinations before DSA inspection.