【病例】巨大VR间隙MR病例影像诊断分析

【临床病史】:无意中发现颅内病变

【影像图片】MRI图像

【病例】巨大VR间隙MR病例影像诊断分析
【病例】巨大VR间隙MR病例影像诊断分析
【病例】巨大VR间隙MR病例影像诊断分析
【病例】巨大VR间隙MR病例影像诊断分析

【影像表现】:矢状位T1WI(A),冠状位T2WI (B),横断位FLAIR (C)、 DWI (D)示额叶、顶叶脑室周围和深部白质区可见多发囊性病变,呈管状,主要分布于血管周围和深部白质区。病灶的信号与脑脊液呈等信号,没有明确的实性部分。病变主要沿穿支动脉分布,邻近脑实质未见明显异常。

Legends:

Sagittal T1WI (A), coronal T2WI (B), axial FLAIR (C), and DWI (D) demonstrate well-delineated rounded and tubular multicystic lesions at the periventricular and deep white matter in the frontal and parietal lobes (right > left). The signal intensities of these cystic lesions corresponded to the cerebrospinal fluid without identifiable solid component. They are distributed along the path of the perforating medullary arteries. The adjacent brain parenchyma is normal.

【影像诊断】:巨大血管周围间隙(VR间隙)

【诊断要点】:Virchow-Robin (VR) spaces are perivascular spaces that surround the blood vessels as they course from the subarachnoid space through the brain.VR间隙又称血管周围间隙,围绕在血管周围,通过蛛网膜下腔穿过大脑。

They may become enlarged, assume bizarre configurations, and cause mass effect.

VR间隙可增大,形态可不规则,伴有占位效应。

Knowledge of their characteristic distribution and signal intensity helps in differentiating them from different pathologic conditions.bTD影像园XCTMR.com

认识VR间隙的分布和信号特点有助于鉴别诊断

【讨论】:

Key Diagnostic Features

VR spaces are isointense to cerebrospinal fluid on all MRI sequences.

VR间隙在MRI各序列均与脑脊液呈等信号。

They are typically seen along the lenticulostriate arteries in the basal ganglia, the perforating medullary arteries in the high convexities of the cerebral white matter, or in the midbrain.

VR间隙常分布于基底节区的豆纹动脉、大脑凸面白质区的穿支动脉、及中脑。

DDx:

Enlarged perivascular spaces: Mucopolysaccharidoses, cryptococcal meningitis

扩大的血管周围间隙:粘多糖病,隐球菌性脑膜炎

Alternative cystic pathologies: Infection (eg, neurocysticercosis), cystic neoplasm, lacunar infarct, cystic encephalomalacia

其他的囊性病变:感染(如脑囊尾蚴病)、囊性肿瘤、腔隙性脑梗塞、囊性脑软化灶。

Rx:

Observation

随访观察

来源:AJNR

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