中枢脑血管病-Central Nervous System.ppt

* * 巨大动脉瘤 * * 小动脉瘤（DSA与3D-TOF） * * * * * * 3D MRA DSA XMF, F/55y, 小动脉瘤 MRA MIP * * YZL, F/57y床突段小动脉瘤 3D MRA 3D DSA DSA * * 静脉血管畸形 * * 静脉血管畸形 * * Cavernous Malformation CT T1WI T2WI SWI * * * * * * * * * * Cavernous Malformation * * Thank you！ * 脑内血肿（T1，T2，turbo-T2)其内有陈旧性出血 * 脑干出血 * 颅内出血 * 小脑出血（PWI，T2FS） * AVM（T1，T2，2D-PC，3D-TOF） * 动脉瘤 * 小动脉瘤（DSA与3D-TOF） Hemorrhagic Cerebral Infarction * * Hemorrhagic StrokeAJNR Am J Neuroradiol 18:1011–1020, June 1997 * * Hemorrhagic Transformation (Koeller, AFIP Stroke Lecture) ? 24 hours after infarct by definition ? Peak: 1-2 weeks ? Diapedesis血细胞渗出 Occurs after reperfusion: the full pressure of arterial blood into hypoxic capillaries results in a diapedesis or red cells moving through the vessel hypoxic walls ? Occurs in up to 50% of strokes ? Confirms ischemic nature of infarct * * Hemorrhagic Transformation /AANLIB/cases/case42/mr1/012.html * * 腔隙性脑梗死lacunar infarction 丘脑基底节区或深部脑髓质小血管(A)闭塞所致 CT征象： 于好发部位见小的低密度灶，一般为1~ 1.5cm大小，早期边界较模糊，中晚期边界较清 MRI检查腔梗灶较CT敏感高，早期更易发现 * * lacunar infarction * * MRI T2WI ,T1WI,flair lacunar infarction * * 存在问题 致死率及致残率 * * 影像学研究策略 脑梗死前期脑缺血的影像学研究 Hypo-P before IS * * Intracranial Hemorrhage Very common Trauma,Hypertension; Aneurysm; Vascular Malformation Others: Embolic stroke with reperfusion; Amyloid angiopathy; Coagulopathies; Drug abuse; Tumor * * CT of Intracranial Hemorrhage All cerebral hematomas, whatever the cause, have a similar resolution pattern on CT. The rate of resolution depends on the size of the hematoma, usually within one to six weeks, and they resorb from the outside toward the center. Perihematoma low density appears in 24-48 hours. Rim enhancement appears in one week and persists for six weeks. The end result of a hematoma is decreased parenchymal density, focal atrophy and local ventricular dilatation. * * * * * * * * 脑内血肿（T1，T2，turbo-T2)其内有陈旧性出血 * * 脑干出血 * * 发病当时CT 发病两年后MRI复查 脑血管畸形(AVM) 影像可以明确诊断，还可以观察大小及血供情况，常有脑萎缩 目前主要是血管成像(DSA、CTA、MRA等)可直接显示畸形血管 * * CT CT