Regional association of developmental venous anomalies with angiographically occult vascular malformations

This study reviews the neuroradiological findings of 43 patients with a developmental venous anomaly In in order to the clinical significance of this entity. All patients underwent unenhanced and contrast-enhanced computer tomography and magnetic resonance tomography, as well as selective angiography, and were followed for at least 2 years In 40% (17 of 43) of patients a cryptic vascular malformation found In the proximity to the developmentmental venous anomaly. Neurolo gical symptoms were present in 8 of 17 patients (47%) in this group. Patients with an isolated developmental venous anomaly had symptoms in 19% (5 of 26), but none of them had experienced a hemorrhage. Magnetic resonance was the most sensitive method for the diagnose of both types of lesions and alterations of the adjacent parenchyma. These results further support that developmental venous anomalies represent a clinically benign entity. However, patient, with an sociation of a developmental venous anomaly and a cryptic vascular malformation are at risk for hemorage from their angiographically occult vascular malformation. Magnetic resonance proved to be the imaging modality of choice for both entities and is appropriate for diagnosis and follow-up.     

脑发育性静脉异常的低场磁共振诊断

目的:探讨脑发育性静脉异常(DVA)的低场强磁共振表现及诊断价值。方法:回顾性分析我院5例DVA的磁共振平扫及增强表现,研究其引流静脉及髓静脉信号特点。结果:5例DVA中平扫有2例异常粗大的引流静脉得以显示,其在T1WI上均为低信号,在T2WI上1例为低信号,1例为高信号,髓静脉未能显示。增强扫描5例均显示了引流静脉及髓静脉,其中两例呈典型的水母头征,另外3例分别显示了引流静脉和邻近的髓静脉。结论:在低场强磁共振上DVA有着不同于高场磁共振的特点。     

The spectrum of symptomatic arterialized developmental venous anomalies: case reports

Developmental venous anomaly (DVA) is an anatomical variation of the intracranial venous system, usually without clinical repercussion. In most cases, DVAs are incidentally diagnosed and should be considered as benign conditions. In rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. The authors present three cases of symptomatic arterialized DVAs: a 28-year-old male with hematoma at the splenium of the corpus callosum and intraventricular hemorrhage, a 53-year-old male patient with a history of epileptic seizures starting recently, and a 25-year-old male patient, previously healthy who started with persistent headaches and hemosiderin deposition in brain parenchyma. These rare cases of arterialized DVAs are conditions that can cause symptoms or show more aggressive behavior with bleeding.     

Parenchymal abnormalities associated with developmental venous anomalies

Introduction To report a retrospective series of 84 cerebral developmental venous anomalies (DVAs), focusing on associated parenchymal abnormalities within the drainage territory of the DVA. Methods DVAs were identified during routine diagnostic radiological work-up based on magnetic resonance imaging (MRI) (60 cases), computed tomography (CT) (62 cases) or both (36 cases). Regional parenchymal modifications within the drainage territory of the DVA, such as cortical or subcortical atrophy, white matter density or signal alterations, dystrophic calcifications, presence of haemorrhage or a cavernous-like vascular malformation (CVM), were noted. A stenosis of the collecting vein of the DVA was also sought for. Results Brain abnormalities within the drainage territory of a DVA were encountered in 65.4% of the cases. Locoregional brain atrophy occurred in 29.7% of the cases, followed by white matter lesions in 28.3% of MRI investigations and 19.3% of CT investigations, CVMs in 13.3% of MRI investigations and dystrophic calcification in 9.6% of CT investigations. An intracranial haemorrhage possibly related to a DVA occurred in 2.4% cases, and a stenosis on the collecting vein was documented in 13.1% of cases. Parenchymal abnormalities were identified for all DVA sizes. Conclusion Brain parenchymal abnormalities were associated with DVAs in close to two thirds of the cases evaluated. These abnormalities are thought to occur secondarily, likely during post-natal life, as a result of chronic venous hypertension. Outflow obstruction, progressive thickening of the walls of the DVA and their morphological organization into a venous convergence zone are thought to contribute to the development of venous hypertension in DVA. Presented at the 44th Annual Meeting of the American Society of Neuroradiology, San Diego, Calif., USA, May 1–5, 2006.     

脑静脉窦血栓形成的MRI诊断

目的 :探讨MRI和MR血管成像 (MRA ,MRV)对脑静脉窦血栓形成 (CVST)的诊断价值。方法 :回顾性分析 10例CVST患者的临床和影像资料。全部病例行常规MRI和MRA( 3DTOF)、MRV( 2DTOF)检查 ,其中 9例行增强扫描。结果 :MR常规扫描示脑实质内均出现异常信号 ,仅 1例T2 WI未见异常信号 ,增强扫描 9例全部出现静脉异常强化。有 5例MRA除可见动脉正常显影外 ,还可见受累的静脉和静脉窦显影。MRV示栓塞的静脉窦不显影或显影欠佳。结论 :常规MRI结合MRA、MRV是诊断CVST的无创和有效手段     

A rare (arteriolo-)capillomedullary venous anomaly of the cerebellum

A rare (arteriolo-)capillomedullary venous anomaly of the cerebellum was examined with CT, MRI, and angiography. Unlike the usual venous angioma, this case had such extraordinary features as: infratentorial location, involvement of the whole left cerebellum, an arteriolocapillary component and a history of progressive vomiting and chronic constipation in a 7-year-old boy. CT and MRI were consistent with an extensive vascular malformation, but the actual diagnosis was reached by angiography.     

Magnetic resonance imaging of intracranial venous angiomas

Magnetic resonance imagings (MRI) were made of intracranial venous angioma (six angiographically proved, four presumed). All draining veins were identified as a linear or a small round structure with a flow void. The stellate configuration was observed in seven of the ten patients. In two of the ten, the associated intraparenchymal hematoma was evident. Increased intensity of adjacent parenchyma on T2-weighted images was detected in four of ten patients, and a decreased intensity on the T1-weighted images was noted in three of eight. Thus, MRI is a pertinent diagnostic modality for evaluating intracranial venous angioma. Angiography does not seem to be required for confirmation in patients with typical MR findings.     

烟雾病的MRI、MRA诊断价值

 目的探讨MRI、MRA对烟雾病(Moyamoya病)的诊断价值.方法对11例Moyamoya病患者行MRI和MRA检查,MRI包括横轴位和矢状位T1WI、T2WI、FLAIR;MRA采用3D TOF法,3例行增强MRA.结果MRI表现为:(1)Moyamoya血管:双侧3例,单侧8例;(2)脑梗死和脑软化灶11例;(3)局部脑萎缩3例.MRA表现为3例双侧颈内动脉狭窄,双侧大脑中、前动脉闭塞,大脑后动脉形成异常血管网;6例右侧颈内动脉、大脑中动脉狭窄;2例左侧颈内动脉、大脑中动脉狭窄.结论MRI能良好的显示脑内病变,MRA能较完整的显示异常血管,MRI与MRA相结合可作为烟雾病诊断的首选检查方法.     

Varix occurring with cerebral venous angioma: a case report and review of the literature

We report a patient in whom a varix occurred with a venous angioma, a rare combination of cerebral vascular malformations. During our review of the 7 previously reported cases, we discovered that all 8 venous angiomas were relatively large and supratentorial, and that the varices involved the veins draining then.     

Cerebral vascular malformations: applications of magentic resonance imaging to differential diagnosis

Summary Twelve patients with cerebral vascular malformations (5 cavernous angiomas, 1 thrombosed arteriovenous malformation, and 6 venous angiomas) were studied with magnetic resonance (MR) imaging. All lesions were clearly depicted. Characteristic MR findings were obtained mainly on T2-weighted images: a markedly low intensity area was always seen. The margins of arteriovenous malformation (AVM) and venous angioma were irregular while those of cavernous angioma were smooth in all planes on T2-weighted images. Gradient-echo (GrE) pulse sequences were more sensitive than T2-weighted spin echo (SE) in lesion detection. MR imaging could play an important role in the differential diagnosis of cerebral vascular malformations.     

Magnetic resonance angiography compared to intra-arterial digital subtraction angiography in patients with subarachnoid haemorrhage

Summary In order to evaluate the sensitivity and specificity of magnetic resonance angiography (MRA) in spontaneous subarachnoid haemorrhage, 14 patients with recent haemorrhage verified by CT or lumbar puncture were investigated with both selective intra-arterial digital subtraction angiography (IA-DSA) and MRA by two independent teams, each having the same preangiographic information. The results were compared with each other and whenever possible (all positive cases except one) with those of surgical intervention. Seven patients were identified by MRA and IA-DSA as having a single aneurysm on the circle of Willis, 1 an aneurysm of the posterior inferior cerebellar artery 1 an aneurysm of the internal carotid artery (siphon) and 2 patients with two aneurysms on the circle of Willis. MRA and IA-DSA both failed to demonstrate aneurysms in 2 cases. Three patients had negative results on both methods and no surgical intervention was attempted. The aneurysms ranged from 0.3 to 1.5 cm in size. In most cases there was agreement between MRA and DSA, leading us to believe that, if the proper protocols are followed, MRA is a powerful alternative to other established methods in the detection of intracranial aneurysms. At this stage it will not replace IA-DSA prior to surgery, but the ability to obtain various projections using 3D MRA may improve surgical planning.     

门静脉和肝静脉系统MRA增强扫描价值的评估

 采用多平面屏气、二维、TOF序列血管成像技术,对59例患者的常规MRA与其中28例患者的增强MRA影像进行分析,比较两者的信号强度与影像质量.评估增强MRA扫描门静脉和肝静脉系统的影像质量与应用价值.影像整体质量评分为不能诊断、差、中等、优、特优,相应评分0～4级.对门静脉主干、门静脉左右支、肝静脉左中右支、脾静脉进行信号强度的测量,所得数据用均数±标准差((x)±s)表示.结果为增强MRA的信号强度与常规MRA信号强度无显著统计学差异(P>0.05).增强MRA血管影像的整体综合评分(优+特优级=75%)高于常规MRA评分(67.74%).增强MRA血管边缘清晰、分支多,优于常规MRA.但由于动静脉同时显影,会使门静脉及肝静脉的观察受影响.门脉高压患者的影像优于门脉系统正常者.     

肺动脉栓塞症及盆腔和下肢深静脉血栓的MR血管成像诊断初探

目的 通过综合应用三维增强磁共振血管成像(3DCE-MRA)和二维(2D)增强快速扰相位梯度回波(FSPGR)检查技术，对肺动脉、盆腔及下肢静脉血栓在1次检查中同时完成不同部位血栓的检出，探讨这种综合性检查方法的临床应用。方法 自2001年1月至2003年5月对临床怀疑有肺动脉栓塞的15例患者进行自动进床团注追踪法的周围血管3DCE-MRA和增强后的2DFSPGR序列扫描。扫描部位包括4部分，即肺、盆腔、大腿、小腿。当肺血管采集完成后，依次进行盆腔、大腿、小腿的采集；尔后再反向按部位进行第2回采集。2DFSPGR序列扫描盆腔、大腿、小腿。15例同时例行肺CT血管造影术(CTA)和(或)DSA检查，12例行下肢静脉多普勒超声检查。结果 15例3DCE-MRA肺扫描中12例获得满意的肺血管成像，15例髂内外静脉、下肢深静脉较动脉的信号强度低，但在后处理时可清楚地分辨静脉结构。15例用增强FSPGR序列扫描的动脉和深静脉均被清楚显示。(1)3DCE-MRA发现14例肺动脉栓塞病变，9例盆腔和下肢静脉血栓病变。表现为多处血栓。(2)2D增强FSPGR序列可作为3DCE-MRA序列的补充，它有更大的扫描范围，即发现髂内静脉属支的血栓。(3)在上述的扫描序列上血栓为低信号，呈偏侧性或腔内充盈缺损；(4)6例静脉血栓局部的管径明显增宽。结论 1次性3DCE-MRA和2D增强FSPGR序列增强扫描可以成为肺动脉栓塞症和盆腔、下肢深静脉血栓的全面检查方法。     

Magnetic resonance imaging and angiography of the brain in embolic left atrial myxoma

Summary A case of left atrial myxoma presenting exclusively with neurological symptoms, studied with magnetic resonance imaging (MRI) combined with cerebral angiography and computed tomography (CT) is reported. Typical angiographic findings suggested the diagnosis of myxoma. MRI showed multiple ischemic lesions disseminated throughout the entire brain, some of which had been clinically asymptomatic. Because of its sensitivity in identifying small cerebral infarcts, MRI should prove in the future to be a first-choice technique in the evaluation of the presence of and extent of cerebral involvement in embolic left atrial myxoma.     

Magnetic resonance angiography in patients with acute stroke treated by local thrombolysis

Although magnetic resonance angiography (MRA) is accepted for showing chronic intracranial stenotic or occlusive lesions, the method has not been practically examined in patients with acute cerebral ischaemia. We carried out three-dimensional time-of-flight MRA in six patients with acute ischaemia treated by local thrombolysis, and compared the findings with those of digital subtraction angiography (DSA). In all patients, MRA before thrombolysis clearly demonstrated the occluded arteries, which corresponded precisely to those shown by DSA. In four patients with complete recanalisation of the occluded vessels after thrombolysis, the recanalisation could be demonstrated by postoperative MRA. In one patient with reocclusion of the recanalised artery, repeat MRA also demonstrated the reocclusion, confirmed by DSA. These results suggest that MRA may be helpful for noninvasive investigation before and after thrombolysis. Received: 10 September 1997 Accepted: 17 January 1998     

Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography

Summary Magnetic resonance angiography (MRA) with flow rephased gradient-echo sequences is a new non-invasive method for vascular imaging. We compared MRA and intra-arterial digital subtraction angiography in 18 patients with intracranial aneurysms to test whether MRA presently provides an alternative to cerebral angiography for the diagnosis of these anomalies. MRA showed 19 of the 22 aneurysms detected (86.4%). However, problems, especially with turbulent or slow flow, resulted in 6 studies (27.3%) with limited and 2 with questionable demonstration of an aneurysm, and 1 false negative study. At present, MRA is definitely inferior to angiography for the demonstration of intracranial aneurysms, due to its lower resolution and other limitations.     

Magnetic resonance tomographic angiography in the investigation of hemifacial spasm

Magnetic resonance angiography (MRA), combined with submillimeter magnetic resonance tomographic angiographic sections (MRTA) showed vascular compression of the 7th cranial nerve or its root exit zone (REZ) in the brain stem in 24 of 37 patients (64.86%) with hemifacial spasm. MRA alone was positive for REZ compression in only 19 (51.4%) cases, while conventional MRI was even less revealing, only 10 (27%) cases being positive.     

Magnetic resonance imaging of cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) represents a diagnostic challenge due to the diversity of clinical presentation. The radiologist should be aware of the common neurological features. Unenhanced CT may show the first indications of venous sinus occlusion. Confirmatory diagnostic imaging should be performed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or computed tomography (CT) venography. We illustrate the MRI and MRV features of the thrombosed venous sinus and venous oedema or infarction and discuss the diagnostic limitations of these techniques.     

MRI监测脑脊液动力学在外伤性脑静脉窦血栓形成临床诊治中的应用

目的探讨运用MRI监测脑脊液循环动力学异常在外伤性脑静脉窦血栓形成临床诊治中的价值。方法对75例脑外伤后临床颅脑血流动力学异常患者及健康志愿者40例,采用MRI 2D-PC cine法序列,以编码流速20cm/s,于颈1～2椎间隙水平测量患者的脑脊液流速、流量,在其接受尿激酶治疗过程中进行随访复查,并与腰穿脑脊液压力进行对照分析。结果颈1～2椎间隙水平脑脊液流动在一个心动周期内均表现为近似于正弦曲线的双向流动,脑外伤组治疗前收缩期、舒张期脑脊液峰值流速、流量均高于正常人群(P<0.05)。经尿激酶治疗后68例患者脑脊液压力恢复正常,其脑脊液收缩期、舒张期脑脊液峰值流速、流量均较治疗前降低(P<0.05)。脑脊液流速与脑脊液压力呈正相关(r=0.805,P<0.05),脑脊液向下净流量与脑脊液压力呈正相关(r=0.794,P<0.05)。结论静脉窦血栓形成前患者脑脊液循环动力学会发生相应改变,磁共振PC-cine法可以早期检测出其循环动力学改变,对脑外伤后患者颅内压改变的监测及预后评价有重要指导意义。     

颅内静脉血栓形成的磁共振诊断

目的:探讨磁共振成像(MRI)及磁共振静脉成像(MRV)对颅内静脉窦血栓形成(CVST)的诊断价值。方法:回顾性分析经临床和影像学方法确诊的14例CVST患者。MR检查技术包括平扫,增强扫描及MRV,14例均行CT平扫,其中1例行DSA检查。结果:14例CVST累及上矢状窦血栓形成4例,横窦血栓形成6例、乙状窦5例,MRI可清晰显示颅内静脉窦血栓形成的直接征象和间接征象,MRV可显示受累静脉窦不显影或者充盈缺损形成。结论:常规MRI结合MRV对颅内静脉窦血栓形成的早期诊断具有重要价值。