颅内发育性静脉异常伴海绵状血管畸形三例患者的临床及影像学特点

Clinical and imaging feature of 3 patients with combined developmental venous anomalies and cerebral cavernous malformations

目的探索颅内发育性静脉异常（DVAs）并发海绵状血管畸形（CCM）的临床及影像学特点。方法对分别以癫痫、头昏、头晕发病的3例患者行头颅MRI磁敏感成像（MRI—SWI）或T2快速梯度回波（T2FFE）、钆喷酸葡胺增强、MRA及全脑血管造影检查。结果MRI—SWI或RFFE可见边缘低信号、中心为不同强度混杂信号的爆米花样或网格状的病灶，分布于额叶皮质及皮质下，提示CCM；在MRI增强及全脑血管造影中可见水母头样表现，提示有DVAs。在分析DVAs和CCM的关系中发现CCM病灶均发生在DVAs区域，可见引流静脉与CCM病灶呈成角弯曲。结论DVAs可并发CCM，影像学可提供有特征性的改变，DVAs血管因素可能是CCM形成的原因之一。

Objective To investigate the clinical, neuroradiologic characteristics and possible causes in 3 patients with combined developmental venous anomalies （DVAs） and cerebral cavernous malformations （ CCM ）. Methods The clinical examination, magnetic resonance imaging （ MRI ） T~ - weighted （ T1 WI）, T2-weighted （ T2 WI）, susceptibility-weighted imaging （SWI） or T2 fast field echo （ T2 FFE） , contrast-enhanced MRI at 1.5 T field strength and digital substrate angiography were performed in 3 patients. Results Three patients presented with the seizure, vertigo, and dizziness respectively. MRI findings of reticulated ＂popcorn like＂ lesion with complete hemosiden rim showed typical sign of CCM. DSA, contrast-enhanced MRI and MRI-SWI revealed the caput medusae of the medullary veins and collected veins which was drained into subcortical and deep venous system, which indicated DVAs in 3 patients. The angulated medullary veins and collected veins in approaching distal zone of CCM were observed. Conclusion DVAs can be combined with CCM. The angulated medullary veins and collected veins combined with CCM in same territory reveals that the angioarchitectural factors is a key factor in pathogenesis of cavernous malformation.