脑发育性静脉异常的CT及MRI诊断(附25例分析)

The value of CT、MRI in diagnosing of brain developmental venous anomaly(25 cases provided)

目的探讨脑发育性静脉异常的MRI、CT及临床表现,提高对该病影像学诊断的认识。方法收集我院近2年经部分手术病理及DSA证实的25例DVA,所有患者均行MRI平扫及增强扫描,9例行CT检查,DSA检查6例,回顾分析其MRI、CT表现。结果发生于幕上15例,幕下10例;CT检查9例,合并脑出血3例,有4例CT平扫未见明确异常密度改变,2例增强扫描见线条形异常增强血管影;MRI能清楚显示所有病变,T1WI、T2WI表现为线条形异常信号22例,合并海绵状血管瘤4例,增强扫描明显显示增粗髓质静脉及引流静脉,部分呈典型的"海蛇头"、"水母头"、"星簇状"等表现;幕上DVA引流静脉经皮层静脉汇入到脑表面静脉窦10例,汇入室管膜下静脉3例,汇入大脑深静脉2例,幕下10例汇入到脑表面静脉7例,汇入到四脑室膜下静脉3例。结论 CT对此病的诊断特异性少,MRI平扫及增强扫描能对99%的DVA作出准确定位定性诊断,故MRI检查能替代CT和DSA成为DVA诊断的首选检查方法。

Objective Exploring the CT、MRI appearance of the brain developmental venous anomaly,to improve our recognition about this disease.Methods We collected 25 cases of DVA confirmed by DSA or histopathology in our hospital in recent two years,all the 25 cases underwent plain and enhanced MRI scan,9 cases with CT examination,6cases with DSA examination.we analysed their image appearance.Results 15 cases Occurred above tentorium of cerebellum,10 cases Occurred under the tentorium of cerebellum.9 cases underwent CT examination and 3 cases with cerebral hemorrhage,4 cases with normal CT appearance.2 cases with enhanced CT scan showed linar enhancing blood vessels.MR scan revealed all the lesions,T1WI and T2WI showed linar abnormal intensity,complicated by cavernous hemangioma in four cases,Enhanced MRI shows medullary veins and the draining vein,typical image showing ＂Caput medusae＂,＂medusa head＂,＇Syar clumps＂shape,7 of 10cases DVA under the tentorium of cerebellum draining into the cerebral venous,and the other 3cases draining into the subependymal veins of the forth cerebral ventricles.Of the 15 cases occurred above tentorium of cerebellum,draining into the venous sinus by cortical vein in 10cases,draining into subependymal veins in 3 cases,and draining into deep cerebral vein in 2cases.Conclusion CT is of litter Specificity in diagnosing of DVA,MRI plain scan companied by enhancement scan can make a correct diagnosis in qualitation and localization diagnosis in about 99% of cases.So MRI examination can be a perfect substitute for CT and DSA as a first choice in diagnosing of DVA.