海绵状血管畸形--英语病例讨论--.pptVIP

Case discussion2012-02-09 Department of Radiology Yangzhou No.1 people’s Hospital Findings CT: Right frontal subcortical lesion. Heterogenous high density mass with mild mass effect without surrounding edema. Anterior horn of the right ventricular is suppressed. midline structures shifted left MR T1WI: heterogenous high SI lesion with focal low SI T2WI: heterogenous with ring of low SI CE: mild enhancement DSA: No obviously abnormal vascular structures DDX Aneurysm Arteriovenous Malformation Capillary Telangiectasia Hypertensive Hemorrhage Metastases Venous Vascular Malformations Cysticercosis, CNS Ganglioglioma Hemangioblastoma, Brain Meningioma Oligodendroglioma Tuberculoma Cavernous Malformations Cavernous Malformations a distinct pathologic subtype of vascular malformation, appearing as a honeycomb of endothelial-lined sinusoidal vascular spaces which contain stagnant blood. angiographically occult Thrombosis, calcification, and hemorrhage are common brain parenchyma may be asymptomatic, seizures are the most common presenting symptom and often necessitate surgery Cavernous Malformations occur anywhere in the CNS and are multiple in 1/3 of cases Surrounding neural tissue may demonstrate gliosis affect males greater than females and occur between third and sixth decade Diagnosis: CT, as well as?MRI, which?is often diagnostic Treatment:? Seizures may necessitate aggressive surgical intervention.? Otherwise, careful observation is indicated. Radiology CT: extensive calcifications = hemangioma calcificans (20%) small round hyperdense region (if malformation is solitary) no surrounding edema or mass effect Radiology MRI Well-defined area of mixed signal intensity centrally (mulberry-shaped lesion) Increased signal intensity: extra cellular met-hemoglobin, slow flow, and thrombosis Decreased signal intensity: deoxy-hemoglobin, intracellular met-hemoglobin, hemosiderin, calficications Surrounding hypointense rim (T2 and FLAIR) = hemosiderin A