MRI在脑动静脉畸形合并自发性出血诊断中的应用

Feasibility of MR imaging in the diagnosis of cerebral arteriovenous malformation with spontaneous hemorrhage

目的探讨磁共振成像(MRI)在诊断脑动静脉畸形(CAVM)合并自发性出血的可行性。方法13例临床怀疑CAVM合并自发性出血患者,其中,5例经手术证实,7例经DSA证实,1例患儿因具有典型MRI表现直接接受!刀放射治疗。所有病例均接受常规MRI检查,8例又经增强扫描。结果常规MRI显示血肿周围细小供血动脉及粗大引流静脉8例,仅发现粗大引流静脉3例,未发现明显畸形血管2例。增强扫描后,血肿已部分吸收,可见细小扭曲的供血动脉及引流静脉。血肿位于额叶4例,枕叶3例,顶叶3例,颞叶2例,基底节区1例。CAVM合并蛛网膜下腔出血3例,硬膜下出血2例,血肿破入脑室1例,大部分病灶位于脑实质内近脑表面和静脉窦旁。结论MRI可清晰显示CAVM的供血动脉、瘤体、引流静脉,并在病灶的确切解剖关系与证实治疗后病灶消失的程度方面具有明显优势,因而,它能为选择最佳治疗提供重要依据。

Objective To discuss the feasibitity of MR imaging in the diagnosis of cerebral arteriovenous malformations （CAVMs） associated with spontaneous hemorrhage. Methods Thirteen patients with clinically suspected CAVMs associated with spontaneous hemorrhage underwent conventional MR imaging. 8 patients underwent additional enhanced MR scans. Of all the patients, 5 cases were confirmed by surgery, 7 cases were confirmed by DSA, and 1 pediatric patient who had typical MR1 findings directly received γ knife radiotherapy. Results Conventional MRI showed that the small blood-supply arteries and coarse drain vein around the hematomas were found in 8 cases, coarse drain vein alone in 3, and no obvious deformity vessels were found in 2. After enhanced scans, the hematomas which had partially absorbed were found to have small-torsional blood-supply arteries and drain vein. For the distribution of the hematomas, four in the frontal lobe, three in the occipal lobe,two in the temporal lobe, and one in the basalganglion area. Subarachnoid hemorrhage was found in 3 cases, Subdural hemorrhage in 2, and the hematoma breaken into cerebral ventricle in 1. Most hematomas were located in cerebral parenchyma approaching brain surface and venous sinus. Conclusion MRI can clearly reveal the blood-supply arteries, tumoral bodies and drain vein of the hematomas and has obvious advantage in showing the exact anatomic relationship of the hematomas and in demonstrating the extent of hematoma obliteration after treatment so that it can provide the important evidence for selecting the optimal therapy.