16例脑发育性静脉畸形磁共振影像诊断
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摘要
目的探讨磁共振技术在诊断脑发育性静脉畸形(DVAs)中的应用和诊断价值。方法回顾性分析2015年11月至2018年5月16例DVAs患者的磁共振影像资料,观察其常规序列及特殊序列[磁敏感加权序列(SWI)以及增强序列]的影像表现,分析其病灶本身特点及其伴发病变的影像特征。结果 16例DVAs均为单发病灶,小脑幕上区8例,小脑幕下区8例。DVAs合并海绵状血管瘤(CA)者11例,其中2例合并多发CA。DVAs在SWI图像和增强T1WI显示清晰(16/16),呈"海蛇头"征、"水母头"征或"伞"征;11例DVAs伴发的CA共15个病灶在SWI图像均表现为大小不等结节样低信号(15/15)。T1WI、T2WI检出DVAs引流静脉4例(4/16),髓静脉2例(2/16)。位于小脑幕上的8例DVAs的引流静脉有3例汇入室管膜下静脉,3例汇入上矢状窦,2例汇入下矢状窦;小脑幕下的8例DVAs的引流静脉5例汇入乙状窦,1例汇入颈静脉窦,2例汇入横窦。伴发的CA病灶均位于引流静脉的"远心端",部分病灶位于中央引流静脉的起始端附近。结论磁共振常规序列结合SWI及增强序列可以提高DVAs的诊断率,进一步揭示其内在特点,为临床提供形态学信息。
Objective To investigate the application and value of MRI in the diagnosis of developmental venous anomaly(DVA). Methods The MRI data of 16 patients who were diagnosed as DVA from November 2015 to May 2018 were retrospectively analyzed. The imaging manifestations of conventional and special sequences such as magnetic susceptibility weighted sequence and enhanced sequence were observed,and the characteristics of the lesion and its associated lesions were analyzed. Results All the 16 DVA were single lesions,and there were 8 cases in supratentorial region and 8 cases in subtentorial region respectively. DVAs combined with cavernous hemangioma(CA) was found in 11 cases,including 2 cases with multiple CA. DVAs showed distinct caput medusae on susceptibility weighted imaging(SWI) and enhanced T1 weighted image(T1WI) in all 16 DVA. In 11 cases of DVAs accompanied by CA,a total of 15 lesions in SWI showed nodular low signal of different size. T1WI and T2WI detected 4 cases of DVAs draining veins,and 2 cases of medullary veins. The drainage veins of 8 cases of DVAs located on the supratentorial region of tentorium cerebelli joined the subependymal veins in 3 cases and the superior and inferior sagittal sinuses in 3 cases. The drainage veins of 8 cases of DVAs located on the subtentorial region of tentorium cerebelli joined the sigmoid sinus in 5 cases,jugular sinus in 1 case and transverse sinus in 2 cases. The concomitant CA lesions were located in the " distal end" of the drainage vein,and some lesions were located near the origin of the central drainage vein. Conclusion Conventional MRI combined with magnetic susceptibility weighted sequence and enhanced sequence could improve the diagnostic rate of DVAs,further reveal its inherent characteristics,and provide morphological information for clinic.
Objective To investigate the application and value of MRI in the diagnosis of developmental venous anomaly(DVA). Methods The MRI data of 16 patients who were diagnosed as DVA from November 2015 to May 2018 were retrospectively analyzed. The imaging manifestations of conventional and special sequences such as magnetic susceptibility weighted sequence and enhanced sequence were observed,and the characteristics of the lesion and its associated lesions were analyzed. Results All the 16 DVA were single lesions,and there were 8 cases in supratentorial region and 8 cases in subtentorial region respectively. DVAs combined with cavernous hemangioma(CA) was found in 11 cases,including 2 cases with multiple CA. DVAs showed distinct caput medusae on susceptibility weighted imaging(SWI) and enhanced T1 weighted image(T1WI) in all 16 DVA. In 11 cases of DVAs accompanied by CA,a total of 15 lesions in SWI showed nodular low signal of different size. T1WI and T2WI detected 4 cases of DVAs draining veins,and 2 cases of medullary veins. The drainage veins of 8 cases of DVAs located on the supratentorial region of tentorium cerebelli joined the subependymal veins in 3 cases and the superior and inferior sagittal sinuses in 3 cases. The drainage veins of 8 cases of DVAs located on the subtentorial region of tentorium cerebelli joined the sigmoid sinus in 5 cases,jugular sinus in 1 case and transverse sinus in 2 cases. The concomitant CA lesions were located in the " distal end" of the drainage vein,and some lesions were located near the origin of the central drainage vein. Conclusion Conventional MRI combined with magnetic susceptibility weighted sequence and enhanced sequence could improve the diagnostic rate of DVAs,further reveal its inherent characteristics,and provide morphological information for clinic.
引文
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[12]卜顺林,白卓杰,张雨涵,等. 3. 0T MR SWI结合常规序列在脑出血病变中的应用价值[J].中国临床研究,2016,29(12):1707.
[13]赵殿阁.磁敏感加权成像术在诊断急性弥漫性轴索损伤中的应用[J].中国临床研究,2014,27(4):472-473.
[14] Haacke EM,Garbern J,Miao Y,et al. Iron stores and cerebral veins in MS studied by susceptibility weighted imaging[J]. Int Angiol,2010,29(2):149-157.
[15] Tong KA,Ashwal S,Obenaus A,et al. Susceptibility-weighted MR imaging:a review of clinical applications in children[J]. AJNR Am J Neuroradiol,2008,29(1):9-17.
[16] Young A,Poretti A,Bosemani T,et al. Sensitivity of susceptibilityweighted imaging in detecting developmental venous anomalies and associated cavernomas and microhemorrhages in children[J]. Neuroradiology,2017,59(8):797-802.
[17] Iv M,Fischbein NJ,Zaharchuk G. Association of developmental venous anomalies with perfusion abnormalities on arterial spin labeling and bolus perfusion-weighted imaging[J]. J Neuroimaging,2015,25(2):243-250.
[2] Faure M,Voormolen M,Van der Zijden T,et al. Developmental venous anomaly:MR and angiographic features[J]. JBR-BTR,2014,97(1):17-20.
[3] Ruíz DS,Yilmaz H,Gailloud P. Cerebral developmental venous anomalies:Current concepts[J]. Ann Neurol,2010,66(3):271.
[4]李迎春,李乐才,刘军,等.脑发育性静脉异常的MR诊断[J].放射学实践,2008,16(9):57-58.
[5] Lasjaunias P,Burrows P,Planet C. Developmental venous anomalies(DVA):the so-called venous angioma[J]. Neurosurg Rev,1986,9(3):233-242.
[6] Robert T,Villard J,Oumarou G,et al. Intracerebellar hemorrhage caused by developmental venous anomaly,from diagnosis to treatment[J]. J Neurol Surg A Cent Eur Neurosurg,2013,74(1):275-278.
[7] Nagatani K,Osada H,Takeuchi S,et al. Surgical resection of developmental venous anomaly causing massive intracerebral haemorrhage:a case report[J]. Br J Neurosurg,2014,28(1):116-118.
[8]李克,刘永晟,王峰.脑发育性静脉异常的研究进展[J].中国脑血管病杂志,2010,7(5):270-273.
[9] Su IC,Krishnan P,Rawal S,et al. Magnetic resonance evolution of de novo formation of a cavernoma in a thrombosed developmental venous anomaly:a case report[J]. Neurosurgery,2013,73(4):739.
[10] Kroll H,Soares BP,Saloner D,et al. Perfusion-CT of developmental venous anomalies:typical and atypical hemodynamic patterns[J]. J Neuroradiol,2010,37(4):239-242.
[11]宋建勋,张水霞,鲁虹霞,等.脑发育性静脉异常及其伴发病变的MRI表现[J].中国医学影像技术,2017,33(4):518-522.
[12]卜顺林,白卓杰,张雨涵,等. 3. 0T MR SWI结合常规序列在脑出血病变中的应用价值[J].中国临床研究,2016,29(12):1707.
[13]赵殿阁.磁敏感加权成像术在诊断急性弥漫性轴索损伤中的应用[J].中国临床研究,2014,27(4):472-473.
[14] Haacke EM,Garbern J,Miao Y,et al. Iron stores and cerebral veins in MS studied by susceptibility weighted imaging[J]. Int Angiol,2010,29(2):149-157.
[15] Tong KA,Ashwal S,Obenaus A,et al. Susceptibility-weighted MR imaging:a review of clinical applications in children[J]. AJNR Am J Neuroradiol,2008,29(1):9-17.
[16] Young A,Poretti A,Bosemani T,et al. Sensitivity of susceptibilityweighted imaging in detecting developmental venous anomalies and associated cavernomas and microhemorrhages in children[J]. Neuroradiology,2017,59(8):797-802.
[17] Iv M,Fischbein NJ,Zaharchuk G. Association of developmental venous anomalies with perfusion abnormalities on arterial spin labeling and bolus perfusion-weighted imaging[J]. J Neuroimaging,2015,25(2):243-250.