脑血管畸形在3.0T MR磁敏感加权成像中表现多样性分析

An analysis of multiform presentations of cerebrovascular malformation on 3.0T susceptibility-weighted imaging

目的:探讨脑血管畸形在3.0T MR磁敏感加权成像(SWI)上表现多样性的病理生理基础。方法:回顾性分析33例具有典型影像学表现或经手术病理证实的脑血管畸形患者。其中海绵状血管瘤24例(2例合并毛细血管扩张症),动静脉畸形(AVM)5例,发育性静脉畸形(DVA)3例,Galen静脉血管畸形合并永存镰状窦1例,毛细血管扩张症(ICT)2例(均合并海绵状血管瘤)。将SWI表现与常规MRI表现及病理结果进行对比分析。结果:SWI表现:24例海绵状血管瘤中15例表现为环状低信号并中心高信号,9例表现为结节状低信号;2例AVM表现为线样低信号及不规则混杂信号,3例表现为混杂等、稍高信号;3例发育性静脉畸形均表现为低信号髓静脉向引流静脉汇聚;1例Galen静脉血管畸形扩张的大脑大静脉呈等信号,2例ICT表现为多发大小不一的细小结节状极低信号区。SWI对海绵状血管瘤、DVA及ICT的显示优于常规MRI,对血流速度快、动静脉分流明显的AVM及Galen静脉血管畸形的显示不及常规MRI及增强扫描。结论:正确认识脑血管畸形的SWI多样性表现与病理生理的关系,有助于脑血管畸形的诊断。

Objective：To discuss the pathophysiological basis of multiform presentations of cerebrovascular malformations on 3.0T MR susceptibility-weighted imaging.Methods：A total of 33 cases with cerebrovascular malformation were collected which had typical iconographical performances or proved by surgery and pathology.Among which 24 cases were cavernous angioma（2 of those have intracerebral capillary telangiectasia,ICT）,5 arterial-venous malformation（AVM）,3 developmental venous malformation（DVA）,one Galen′s vein vascular malformation combined with persistant falcial sinus.The differences among the iconographical performance on SWI,routine MR and pathology were observed.Results：Of the 24 cases of cavernous hemangioma,15 cases showed ring-shaped low signal with central high signal,9 cases showed nodular low signal;2 cases of AVM showed linear low signal and irregular mixed-signal,3 cases showed mixed and slightly higher signal;3 cases of DVA showed low signal medullary veins converging to the draining vein;In one case of Galen′s venous malformation the dieated vena magna appeared isointense.SWI demonstrated cavernous angioma,DVA and ICT clearly than with conventional MR scanning.But for demonstration of AVM and Galen′s venous malformation with fast blood flow and obvious arterio-venous shunt,SWI was inferior to conventional MR scanning and enhanced scanning.Conclusion：Correct understanding of the relationship of multiform presentations of SWI converging of cerebrovascular malformation and pathophysiology will help the diagnosis of this disease.