Imaging characteristics of symptomatic vertebral artery dissection: a systematic review.
Imaging characteristics of symptomatic vertebral artery dissection: a systematic review.
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DOI：
10.1097/nrl.0b013e3182675511
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Newman-Toker DE
中科院分区：
文献类型：
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作者：
Gottesman RF;Sharma P;Robinson KA;Arnan M;Tsui M;Saber-Tehrani A;Newman-Toker DE
椎动脉夹层（VAD）是年轻人中风的重要原因。VAD可以表现出一系列的影像学表现。我们试图总结各种影像学表现在症状性VAD患者中的诊断价值。我们对观察性研究进行了系统回顾，在电子数据库（MEDLINE，EMBASE）中搜索了5例以上具有VAD临床或放射学特征的受试者的英文手稿。两名独立评审员选择纳入研究;第三名评审员裁定差异。对研究的方法学质量进行了评估，并提取了成像数据。计算合并比例。在3996篇引文中，我们筛选了511篇手稿，并选择了75篇描述1,972例VAD患者的研究。大多数研究使用传统血管造影或磁共振血管造影（MRA）诊断VAD; CT血管造影（CTA）和多普勒超声检查的描述较少。报告的影像学表现为椎动脉狭窄（51%）、串珠状（48%）、动脉扩张（37%）、动脉闭塞（36%）和假性动脉瘤、双腔和内膜瓣（各22%）。在以传统血管造影为参考标准的病例中，CTA（100%）比MRA（77%）或多普勒超声（71%）更敏感（p=0.001）。VAD患者的影像学表现差异很大，大多数VAD患者没有单一的影像学体征。非特异性放射学征象占优势。相对于传统血管造影术，CTA可能比MRA或超声对夹层具有更高的敏感性。需要对VAD受试者的影像学技术和放射学标准进行更高质量的研究。未来的研究应在明确定义的未分化的临床VAD可疑人群中比较成像技术。
Vertebral artery dissection (VAD) is an important cause of stroke in the young. VAD can present with a range of imaging findings. We sought to summarize the diagnostic value of various imaging findings in patients with symptomatic VAD. We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for English-language manuscripts with >5 subjects with clinical or radiological features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality and imaging data were abstracted. Pooled proportions were calculated. Of 3996 citations, we screened 511 manuscripts and selected 75 studies describing 1,972 VAD patients. Most studies utilized conventional angiography or magnetic resonance angiography (MRA) to diagnose VAD; CT angiography (CTA) and Doppler ultrasonography were described less frequently. Imaging findings reported were vertebral artery stenosis (51%), string and pearls (48%), arterial dilation (37%), arterial occlusion (36%), and pseudoaneurysm, double lumen, and intimal flap (22% each). In cases where conventional angiography was the reference standard, CTA was more sensitive (100%) than either MRA (77%) or Doppler ultrasonography (71%) (p=0.001). Imaging findings vary widely in patients with VAD, with no single radiographic sign present in the majority of VAD patients. Non-specific radiographic signs predominate. CTA probably has greater sensitivity for dissection than MRA or ultrasound relative to conventional angiography. Higher quality studies on imaging techniques and radiographic criteria in subjects with VAD are needed. Future studies should compare imaging techniques in well-defined, undifferentiated populations of clinical VAD suspects.