脑实质内海绵状血管瘤的影像学诊断

Imaging diagnosis of cerebral cavernous hemangioma

目的 :探讨脑实质内海绵状血管瘤 (CA)的CT、MRI、MRA和DSA表现并比较四种影像学检查方法的诊断价值。方法 :回顾性分析 2 0例CA的影像学表现 ,其中 15例经手术病理证实 ,5例经影像学及临床随访证实。 2 0例进行CT和MRI平扫、MRA ,13例行CT增强扫描 ,15例行MRI增强扫描 ,12例行DSA检查。结果 :CA可发生于脑内任何部位 ,以单发多见 (17/ 2 0 ,占 85 % )。 2 0例CA检出 2 5个病灶。CT和MRI平扫均发现所有病灶。CA的CT平扫均表现为高密度或稍高密度 ;13例CT增强扫描发现 15个病灶 ,其中 10个病灶无强化 ,5个病灶轻度强化。CA的MRI平扫表现为T1WI呈等或低信号 12个 ,高信号 8个 ,混杂信号 5个 ;T2 WI全部病灶均表现为高低混杂信号 ,2 3个病灶周围伴有低信号环 ,2个病灶周围有水肿带 ,无占位效应 ;15例MRI增强扫描发现 17个病灶 ,其中 7个病灶出现瘤体血管床轻中度强化 ,2个病灶边缘强化 ,8个病灶无强化。 2 0例CA行 3DTOFMRA均未见异常血管影。 12例行全脑DSA检查未见供血动脉与引流静脉 ,4例表现为毛细血管期或静脉窦期富血管性病变。结论 :CA具有较典型的影像学表现 ,CT和MRI平扫对明确诊断具有重要意义 ,且MRI优于CT ;CA的CT和MRI增强扫描无特征性表现 ;MRA和DSA对诊断CA价值有限。

Objective:To discuss CT,MRI,MRA and DSA features of cerebral cavernous hemangioma and compare diagnostic value of the methods for the disease.Methods:The data of 20 cases with cerebral cavernous hemangioma was analyed retrospectively and 15 cases with pathologically proved.20 cases were examined with plain CT scan,plain MRI and MRA.13 cases with contrast-enhanced CT,15 cases with Gd-DTPA enhanced MRI,and 12 cases with DSA.Results:Most cerebral cavernous hemangioma was single (17/20,85%) and occurred at any site in the brain.On plain CT scans,25 lesions were detected in 20 cases which presented high density or slightly-high density.On enhanced CT scans,15 lesions were found in 13 cases,of which 10 lesions showed no enhancement while 5 lesions showed slight enhancement.MRI demonstrated 25 lesions in 20 cases,of which 12 lesions displayed iso-intense signal,8 lesions high-intense signal and 5 lesions mixed signal on T 1WI.All lesions displayed mixed signal on T 2WI,23 lesions displayed ring-like low-signal,and 2 lesions showed perifocal edema,no mass effect was present in most cases.17 lesions were found in 15 cases,of which 7 lesions showed slight enhancement,2 lesions showed slight enhancement on the round,while 8 lesions showed no enhancement.Both 20 cases with 3D TOF MRA and 12 cases with DSA examination could not showed any supplied-artery and veins,of which 4 cases showed faint staining from capillary stage to sinus stage on DSA images.Conclusion:Cerebral cavernous hemangioma has characteristic imaging features.Both CT and MRI are of great value in the diagnosis of the disease and MRI is superior to CT in displaying the lesion.Both MRA and DSA are less valuable in the diagnosis of cerebral cavernous hemangioma.