课件：大脑动静脉畸形影像学多序列表现.ppt

男，34岁，反复发作性四肢抽搐 A图：CT平扫见右顶部有一边缘不清的片状及纡曲条状高密度影 B图：CT增强见区域内斑点状及条状强化，边缘不清，无占位性 C图：MRA造影：脑右侧动脉的顶后支及脑后动脉的顶枕支增粗， 并于两支血管吻合处见一畸形血管团 Classic superficial type brain AVM in an 18-year-old man who presented with a left parietal hematoma. (a) Axial contrast material–enhanced CT scan shows a tangle of intensely enhancing tubular structures embedded in the left parietal lobe, a finding that is compatible with a nidus.Hyperattenuation representing intraventricular hemorrhage is noted in the ventricles (b) Maximum intensity projection image (basal view) from CT angiographic data shows enlargement of the left middle cerebral artery (MCA) (relative to the right side), which supplies the nidus (c) Lateral left internal carotid angiogram reveals a glomerular type nidus in a cortical location,supplied mainly by the posterior parietal and angular branches of the left MCA, with early drainage into a left parietal cortical vein, findings that confirmed the diagnosis of a brain AVM Classic deep type brain AVM in a 19-year-old woman who presented with sudden headaches followed by loss of consciousness. Bilateral cranial nerve VI palsy was seen at physical examination. (a, b) Axial unenhanced (a) and contrast-enhanced (b) CT scans show intensely enhancing vascular structures at the left thalamus. Although no evidence of hemorrhage was seen at CT, there was strong clinical suspicion for rupture. (c) Lateral left vertebral angiogram helps confirm the presence of a thalamic brain AVM, supplied by the thalamoperforator vessels and left posterior choroidal branches and draining mainly into the vein of Galen and minimally into the left basal vein of Rosenthal (arrows). Note the small venous pouches (arrowheads), whose presence suggests a high risk of hemorrhage 鉴别诊断——脑挫裂伤 CT：平扫上急性期显示脑内低密度病灶，伴有点片状高密度出血及明显占位征象，后期显示脑内局灶软化灶伴有脑萎缩征象 MRI：T2WI为高信号，T1WI为低信号，早期有占位征象，后期有萎缩征象 鉴别诊断——脑挫裂伤 右额挫伤 鉴别诊断——颅内动脉瘤 CT： 1.无血栓动脉瘤 呈圆形稍高密度影，边界清晰，增强时呈均匀强化 2.部分血栓动脉瘤