颅颈交界区硬脑膜动静脉瘘的CT、MRI表现
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摘要
目的:分析颅颈交界区硬脑膜动静脉瘘(DAVF)的CT、MRI影像学特点。方法:回顾性分析15例经DSA证实的颅颈交界区DAVF的临床病史及影像学资料;其中男性10例,女性5例;平均年龄49.5岁;15例中有4例急性起病,3例亚急性起病,8例慢性起病。15例患者均行MR平扫检查,其中10例同时行增强扫描,进行MRV检查者2例,行MRA、SWI、PWI检查者各1人;另有5例接受了CT平扫检查以及CTA检查。结果:MR表现为颅内或颅颈交界区的流空血管影,邻近脑、脊髓组织的肿胀及异常信号。CT表现脑表面的多发增粗血管影及部分间接征象。CTA、MRA、MRV及SWI均可显示迂曲扩张的血管网。结论:CT和MRI可以为颅颈交界DAVF的诊断提供帮助,特别是脑或脊髓表面异常增多的血管影是诊断DAVF的重要线索。
Purpose: To investigate the CT and MRI features of dural arteriovenous fistula(DAVF) of the craniocervical junction. Methods: The clinical history and imaging data of 15 patients(10 male and 5 female; mean age 49.5 years) with DAVF of the craniocervical junction confirmed by DSA were analyzed retrospectively. Among the 15 patients, 4 cases were acute onset, 3 cases were subacute onset, and 8 were chronic onset. All 15 patients were performed with MRI plain scan, 10 patients underwent MRI contrast-enhancement scan simultaneously, 2 patients underwent MRV examination. Three patients were performed SWI, MRA and PWI respectively. Other 5 patients underwent CT plain scan and CTA examination. Results: MRI showed the flow void blood vessels in the brain or at the craniocervical junction area, swelling and abnormal signal at the adjacent brain parenchyma and spinal cord tissue. CT showed multiple thickened vessels on the surface of the brain and other indirect signs. CTA, MRA, MRV,and SWI were all available to demonstrate tortuous and dilated vascular network. Conclusion: Imaging of CT and MRI can provide valuable clues for diagnosis of DAVF, especially the feature of abnormal vascular at the brain or spinal cord surface.
Purpose: To investigate the CT and MRI features of dural arteriovenous fistula(DAVF) of the craniocervical junction. Methods: The clinical history and imaging data of 15 patients(10 male and 5 female; mean age 49.5 years) with DAVF of the craniocervical junction confirmed by DSA were analyzed retrospectively. Among the 15 patients, 4 cases were acute onset, 3 cases were subacute onset, and 8 were chronic onset. All 15 patients were performed with MRI plain scan, 10 patients underwent MRI contrast-enhancement scan simultaneously, 2 patients underwent MRV examination. Three patients were performed SWI, MRA and PWI respectively. Other 5 patients underwent CT plain scan and CTA examination. Results: MRI showed the flow void blood vessels in the brain or at the craniocervical junction area, swelling and abnormal signal at the adjacent brain parenchyma and spinal cord tissue. CT showed multiple thickened vessels on the surface of the brain and other indirect signs. CTA, MRA, MRV,and SWI were all available to demonstrate tortuous and dilated vascular network. Conclusion: Imaging of CT and MRI can provide valuable clues for diagnosis of DAVF, especially the feature of abnormal vascular at the brain or spinal cord surface.
引文
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[17]Letourneau-Guillon L,Krings T.Simultaneous arteriovenous shunting and venous congestion identification in dural arteriovenous fistulas using susceptibility-weighted imaging:initial experience.AJNR,2012,33:301-307.
[18]李静伟,杨帆,李桂林,等.寰枕交界区硬脊膜动静脉瘘诊治进展.中国脑血管病杂志,2015,12:600-603.
[19]Kulwin C,Bohnstedt BN,Scott JA,et al.Dural arteriovenous fistulas presenting with brainstem dysfunction:diagnosis and surgical treatment.Neurosurg Focus,2012,32:E10.
[2]Candhi D,Chen J,Pearl M,et al.Intracranial dural arteriovenous fistulas:classification,imaging findings,and treatment.AJNR,2012,33:1007-1013.DOI:10.3174/ajnr.A2798.
[3]Tsai LK,Jeng JS,Liu HM,et al.Intracranial dural arteriovenous fistulas with or without cerebral sinus thrombosis:analysis of 69patients.J Neurol Neurosurg Psychiatry,2004,75:1639-1641.
[4]Lasjaunias P,Chiu M,ter Brugge K,et al.Neurological manifestations of intracranial dural arteriovenous malformations.J Neurosurg,1986,64:724-730.
[5]Lee J,Lim YM.Clinical presentation,imaging findings,and prognosis of spinal dural arteriovenous fistula.J Clin Neurosci,2016,26:105-109.
[6]Jeng Y,Chen D YT,Hei HL,et al.Spinal Dural Arteriovenous Fistula:Imaging Features and Its Mimics.Korean Journal of Radiology,2015,16:1119-1131.
[7]Wang J Y,Molenda J,Bydon A,et al.Natural history and treatment of craniocervical junction dural arteriovenous fistulas.J Clin Neurosci,2015,22:1701-1707.
[8]Gilard V,Curey S,Tollard E,et al.Coincidental vascular anomalies at the foramen magnum:Dural arteriovenous fistula and high flow aneurysm on perimedullary fistula.Neuro-Chirurgie,2013,59:210-213.
[9]Letourneau-Guillon L,Cruz J P,Krings T,et al.CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas:Findings associated with cortical venous reflux.Eur J Radiol,2015,84:1555-1563.
[10]Cognard C,Gobin YP,Pierot L,et al.Cerebral dural arteriovenous fistulas:clinical and angiographic correlation with a revised classification of venous drainage.Radiology,1995,194:671-680.
[11]Hacein-Bey L,Konstas AA,Pile-Spellman J.Natural history,current concepts,classification,factors impacting endovascular therapy,and pathophysiology of cerebral and spinal dural arteriovenous fistulas.Clin Neurol Neurosurg,2014,121:64-75.
[12]Liu X,Ogata A,Masuoka J,et al.Dural arteriovenous fistula manifesting as pontine hemorrhage at the craniocervical junction.Acta Neurochir,2017,159:831-834.
[13]Aviv RI,Shad A,Tomlinson G,et al.Cervical dural arteriovenous fistulae manifesting as subarachnoid hemorrhage:report of two cases and literature review.AJNR,2004,25:854-858.
[14]Farb RI,Kim JK,Willinsky RA,et al.Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography:initial experience.Radiology,2002,222:843-850.
[15]Luetmer PH,Lane JI,Gilbertson JR,et al.Preangiographic evaluation of spinal dural arteriovenous fistulas with elliptic centric contrastenhanced MR angiography and effect on radiation dose and volume of iodinated contrast material.AJNR Am J Neuroradiol,2005,26:711-718.
[16]Mossa-Basha M,Chen J,Gandhi D.Imaging of cerebral arteriovenous malformations and dural arteriovenous fistulas.Neurosurg Clin NAm,2012,23:27-42.
[17]Letourneau-Guillon L,Krings T.Simultaneous arteriovenous shunting and venous congestion identification in dural arteriovenous fistulas using susceptibility-weighted imaging:initial experience.AJNR,2012,33:301-307.
[18]李静伟,杨帆,李桂林,等.寰枕交界区硬脊膜动静脉瘘诊治进展.中国脑血管病杂志,2015,12:600-603.
[19]Kulwin C,Bohnstedt BN,Scott JA,et al.Dural arteriovenous fistulas presenting with brainstem dysfunction:diagnosis and surgical treatment.Neurosurg Focus,2012,32:E10.