海绵状血管畸形英语病例讨论2012课件

Case discussion 2012-02-09 Department of Radiology Yangzhou No.1 peoples Hospital 26 Y.O female complained seizure accompanied loss of consciousness.normal PE . No obviously abnormal history CT CT:60HU Follow up MRI 2 weeks later CE MRI follow up 4 weeks later Findings vCT: 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 vMR T1WI: heterogenous high SI lesion with focal low SI T2WI: heterogenous with ring of low SI CE: mild enhancement vDSA: No obviously abnormal vascular structures DDX vAneurysm vArteriovenous Malformation vCapillary Telangiectasia vHypertensive Hemorrhage vMetastases vVenous Vascular Malformations vCysticercosis, CNS vGanglioglioma Hemangioblastoma, Brain vMeningioma vOligodendroglioma vTuberculoma vCavernous Malformations Cavernous Malformations va distinct pathologic subtype of vascular malformation, appearing as a honeycomb of endothelial-lined sinusoidal vascular spaces which contain stagnant blood. v angiographically occult vThrombosis, calcification, and hemorrhage are common vbrain parenchyma may be asymptomatic, seizures are the most common presenting symptom and often necessitate surgery Cavernous Malformations voccur anywhere in the CNS and are multiple in 1/3 of cases vSurrounding neural tissue may demonstrate gliosis vaffect males greater than females and occur between third and sixth decade vDiagnosis: CT, as well as MRI, which is often diagnostic vTreatment: Seizures may necessitate aggressive surgical intervention. Otherwise, careful observation is indicated. Radiology vCT: extensive calcifications = hemangioma calcificans (20%) small round hyperdense region (if malformation is solitary) no surrounding edema or mass effect Radiology vMRI 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 vAngio: negative - “occult cerebrovascular malformation, OCVM Pearls vCharacteristic T2WI findings of a well- defined “mulberry “ lesion with complete hemosiderin ring vNo surrounding edema or mass effect: distingui