20例未出血性脑动静脉畸形的CT、MR诊断与临床价值

Nonhemorrhagic Cerebral Arteriovenous Malformation CT and MR Diagnosis and the Clinical Value:20 Patients

目的评价计算机体层摄影(CT)及磁共振(MR)诊断颅内未出血性动静脉畸形(nAVM)的价值与限度。方法 20例经数字减影血管造影(DSA)证实的颅内nAVM病例,全部行CT平扫、MR平扫加增强及磁共振血管成像(MRA)检查,5例行磁敏感加权成像(SWI)及三维增强磁共振血管成像(3D CEMRA)检查。结果 20例中15例位于脑皮质及皮髓交界区,2例位于深部脑白质,2例位于侧脑室内,1例位于幕下,CT平扫表现为以高密度为主的高、等、低混杂密度;16例表现为特征性MR流空血管影,其中12例显示明确的供血动脉及引流静脉,5例3D CE MRA均显示明确的异常血管团;1例位于直窦旁,以局部脑质萎缩为主;1例左侧脑室前角旁,以血栓机化为主。结论 nAVM随诊期间的出血预测因素为易出血脑动静脉畸形表现,复杂的供血与深静脉引流方式,自发性出血较低的nAVM患者无此类因素存在;MR平扫结合MRA、SWI、3D CE MRA各序列成像对异常血管团的显示优于DSA,对nAVM能无创性准确定位、定性,并可显示其结构组成,可作为临床高度怀疑脑nAVM患者的首选影像检查方法。

Objective To assess the value and limitation of CT and MR in the diagnosis of intracranial nonhemorrhagic arteriovenous malformation（AVM）.Methods In 20 cases confirmed by DSA intracranial nonhemorrhagic AVM,routine CT scan,routine and contrast enhanced MR and MRA examination were done on all,SWI and 3D CE MRA examination were done on 5 cases.Results Among the 20 patients 15 cases in the cerebral cortex and cortical medullary junction,2 cases were located in the deep white matter,2 cases located in the lateral ventricles,1 cases under the screen,conventional CT scanning performance is high density,isodensity and low density hybrid,mainly high density;16 cases showed the characteristic of MR vascular signal void,among which 12 cases showed clear feeding arteries and draining veins,5 cases of 3D CE MRA showed clear abnormal vascular group;1 was located next to the straight sinus,cerebral parenchymal atrophy;1 case of left ventricle anterior horn side,dominated by thrombus calcification.Conclusion Nonhemorrhagic AVM follow-up period bleeding predictors are easy bleeding AVM,complex supply and deep venous drainage,low spontaneous hemorrhage nonhemorrhagic AVM patients have no such factors;MR regular scans combined with MRA,SWI,3D CE MRA imaging of abnormal vascular mass are superior to DSA,which can realize noninvasive accurate positioning,qualitative identification of nonhemorrhagic AVM,and can display the structure,thus can be used as an optimal imaging test for highly suspicious brain nonhemorrhagic AVM in clinic.