CT血管成像诊断颅内动脉开窗畸形合并静脉畸形

Diagnosis of Fenestration of Intracranial Artery Combined with Intracranial Venous Malformation with CT Angiography

目的分析颅内动脉开窗畸形(FIA)合并颅内静脉畸形(IVM)的CT血管成像(CTA)特点,以提高对该血管变异的认识。资料与方法回顾性分析3868例患者的头颅CTA资料,将所有原始图像进行后处理,得到容积重组图像和最大密度投影图像并进行分析。结果 3868例行头颅CTA检查的患者中,FIA合并IVM11例,检出率为0.28%,FIA共12处,其中前交通动脉开窗6处,椎基底动脉开窗3处,大脑前动脉开窗1处,大脑中动脉开窗1处,大脑后动脉开窗1处;裂隙型开窗9处,凸透镜型开窗3处。11例患者中,10例IVM位于幕上,其中颞叶3例,枕叶3例,额叶2例,基底节1例,顶叶1例;仅1例IVM位于幕下,其中7例CT平扫表现为IVM相应部位出血。结论 FIA可以伴发静脉畸形的发生,其机制有待进一步探索,CTA对于FIA合并IVM这一变异具有一定的诊断价值,可以作为首选影像学检查。

Purpose To analyze the CT angiography （CTA） features of fenestration of intracranial artery （FIA） combined with intracranial venous malformation （IVM） in an effort to improve recognition of these variations. Materials and Methods The image data of 3,868 patients who underwent CTA examination were evaluated retrospectively. The reconstructed images were processed by using volume rending （VR） and maximal intensity projection （MIP） techniques. Results Among those 3,868 patients, I I were found with FIA combined with IVM, and the prevalence was 0.28%. Twelve fenestrations were detected, among which 6 were located in anterior anterior communicating artery, 3 were in vertebrobasilar artery, 1 was in anterior cerebral artery, 1 was in middle cerebral artery, and the last 1 was in posterior cerebral artery. Nine out of these 12 fenestrations were small in slit-like shape, and 3 were larger in convex-lens-like shape. Among these 11 patients, 10 had supratentorial IVMs, among which 3 1VMs were located in temporal lobe, 3 were in occipital lobe, 2 were in frontal lobe, 1 in basal ganglia, and the rest I was in parietal lobe. It showed only one patient with infratentorial IVM. The plain CT scan demonstrated that 7 patients had hematoma in the areas of IVM. Conclusion FIA may be associated with the occurrence of 1VM, and the mechanism needs further study. As a valuable technique to detect variations of FIA associated with IVM, CTA can be used as the first choice.