颅内海绵状血管瘤的影像特点及治疗分析

Clinico-radiological features and treatment of intracranial cavernous angiomas

目的探讨颅内海绵状血管瘤(ICA)的临床表现、影像学特点及治疗方法。方法回顾性分析52例经病理或随访证实的ICA患者的临床及影像学资料,着重观察CT、MRI表现及治疗效果。结果 52例患者中单发者48例,多发者4例,共有病灶63个。脑内型54个,脑外型9个。脑内型好发于幕上脑实质,以额、颞叶多见(38/54,70.37%)。CT多表现为结节状高密度灶,部分可见钙化,边界清,大多无占位效应。MR信号特点复杂,根据分型,以Ⅱ型病灶最多见(32/54,59.26%),T_1WI、T_2WI均为混杂信号,呈桑葚样或爆米花样改变;T_2WI上病灶周围低信号环也是其特征性表现(46/54,85.18%)。增强扫描呈点片状轻度强化(59.26%)或无明显强化(40.74%)。脑外型多见于中颅窝海绵窦,T_2WI呈高信号及增强显著强化是其特点,常伴占位效应。经手术治疗39例(39/52,75%),经伽马刀放射治疗5例(5/52,9.62%),保守治疗8例(8/52,15.38%),术后出现脑出血者4例,神经功能损害者3例。结论颅内海绵状血管瘤的CT、MRI表现对诊断具有重要价值,对指导治疗方案有一定的帮助。ICA治疗方法以手术切除为主,保守治疗或放射疗法也可作为选择。

Objective To investigate the clinico-radiological features and treatment of intracranial cavernous angiomas. Methods The clinical and radiological data of 52 patients who confirmed with pathology or follow-up were analyzed retrospectively. The CT,.MRI features and the management of cavernous angiomas were evaluated emphatically. Results Among 52 cases,.48 cases had single lesion and 4 had multiple lesions,.totally 63 lesions..There were 54 intracerebral cavernous angiomas and 9 extracerebral cavernous angiomas..Intracerebral cavernous angiomas occurred mostly in supratentorial brain parenchyma , especially in frontal and temporal lobes.（38/54,70.37%）. Cavernomas usually manifested as high density and well-defined lesions, sometimes with calcifications on CT..There was no mass effect on adjacent structures..The MRI features were complex and changeable. According to the classification, typeⅡwas the most common category （32/54, 59.26%）. Both T1 and T2-weighted images showed heterogenous signal intense and presented as “mulberry” or “popcorn”. A hypointense rim in the surrounding brain parechyma is another feature of cavernous angiomas. （46/54,.85.18% ）..On contrast -enhanced MRI,.cavernomas performed as minimal enhancement （59.26%） or non-enhancement （40.74%）. Extracerebral cavernous angiomas often occurred in cavernous sinus , and were characterized by high signal intensity on T2WI and significantly enhancement with mass effect. 39 cases underwent surgery （39/52, 75%）, 5 cases underwent γ knife radiosurgery （5/52, 9.62%） and 8 cases chose conservative treatment （8/52, 15.38%）. After surgery, there were hemorrhage in 4 cases and neurological impairment in 3 cases. Conclusion The CT and MRI features of intracranial cavernous angiomas have a high value in the diagonosis and could provide some guidance on the treatment. Surgery was the main choice for most cavernomas ,.conservative treatment or radiosurgery could become another alternative to surgery.