血管读片-血管周围间隙课件

1、早读片 主班：江远亮指导老师：刘崎教授病例57岁女性2001年起反复发作左侧肢体活动不利索和频繁头痛2004年磁共振检查发现左侧大脑半球异常信号其他病史无特殊，神经系统检查及 实验室各项检查均阴性T2WI2010年磁共振 fluid-attenuated inversion recoveryDWIfluid-attenuated inversion recovery 2004年磁共振T2WIdiagnosisExtensive Unilateral Widening of Virchow-Robin SpacesVirchow-Robin Spacesat MR ImagingIntroduc

2、tionnamed after Rudolf Virchow (German pathologist, 18211902) (1) and Charles Philippe Robin (French anatomist, 18211885) perivascular spaces /血管周围淋巴间隙AnatomyVR spaces surround the walls of arteries, arterioles,veins, and venules as they course from the subarachnoid space through the brain parenchym

3、aElectron microscopy and tracer studies have given insight into the location of VR spaces and clarified that the subarachnoid space does not communicate directly with the VR spacesVirchow-Robin spaces on magnetic resonance images: normative data, their dilatation, and a review of the literature Neur

4、oradiology (2006) 48:745754PrevalenceSmall VR spaces (2 mm) appear in all age groups. With advancing age, VR spaces are found with increasing frequency and larger apparent size (2 mm)MR technique： Heavier T2-weighted imaging, thinner sections, high-field-strength MRDilated VR SpacesDilatation of VR

5、spaces was described by Durant-Fardel in 1843 （3mm）The mechanisms underlying expanding VR spaces are still unknowndVRS is an indicator of cerebral small vessel diseases such as leukoaraiosis and lacune.Locations and MorphologyDilated VR spaces typically occur in three characteristic locationstype It

6、ype IItype IIIThe first type (type I) is frequently seen on MR images and appears along the lenticulostriate arteries entering the basal ganglia through the anterior perforated substancea Basal view of the cadaveric brain. Arrows indicate the basalsegment of the V-R spaces. OC optic chiasm, M mamill

7、ary body, Ppons, I olfactory nerve, III oculomotor nerve. b, c Coronal 3 T MRimages showing the basal segment of the V-R spaces (arrows)The second type (type II) can be found along the path of the perforating medullary arteries as they enter the cortical gray matter over the high convexities and ext

8、end into the white matterThe third type (type III) appears in the midbrain.In the lower midbrain, VR spaces at the pontomesencephalic junction surround the penetrating branches of the collicular and accessory collicular arteriesAppearance at MR Imagingwell-defined oval,rounded, or tubular structures

9、, smooth margins, commonly appear bilaterally, and usually measure 5 mm or lessVisually, the signal intensities of the VR spaces are identical to those of CSF with all pulse sequencesAtypical VR SpacesOccasionally, VR spaces appear markedly enlarged, cause mass effect, and assume bizarre cystic conf

10、igurations that may be misinterpreted as other pathologic processes, most often a cystic neoplasmGiant VR spaces in the mesencephalothalamic region in a 19-year-old manShiratori K, Mrowka M, Toussaint A, SpalkeG, Bien S. Extreme, unilateral wideningVirchow-Robin spaces: case report. Neuroradiology20

11、02;44(12):990992.DifferentialDiagnostic ConsiderationsLacunar InfarctionsCystic Periventricular LeukomalaciaMultiple SclerosisCryptococcosisMucopolysaccharidosesCystic NeoplasmsNeurocysticercosisArachnoid CystsNeuroepithelial CystsLacunar InfarctionsVs type II Vs type III Lacunar InfarctionsVs type

12、I Periventricular Leukomalacia usually seen in premature infants, is a leukoencephalopathy resulting from a pre- or perinatal hypoxic-ischemic eventacute stage/End-stage(a typical appearance at MR imaging)Symmetrical/compensatory focal ventricularEnlargement/Corpus callosal thinning/surrounding glio

13、sisPeriventricular LeukomalaciaCystic periventricular leukomalacia in a 3-year-old boy with a history of perinatal asphyxia who had delayed motor and mental development and epilepsyOvoid MS lesion of the centrum semiovale in a 49-year-old manParenchymal neurocysticercosisin the vesicular stage in a

14、17-year-old boyCryptococcosis in a 58-year-oldwoman with headaches and fever who wasseropositive for human immunodeficiencyvirus. Parasagittal T2-weighted image (5963/120) shows multiple dilated VR spaces inthe region of the basal ganglia (arrowheads).C neoformans was cultured from the CSF.Hurler sy

15、ndrome (mucopolysaccharidosis type I) in a 2-year-old boy with typicalexternal features of this syndromeDesmoplastic pilocytic astrocytoma of the right thalamus, cerebral peduncle, and brainstem in a 15-year-old girlNeuroepithelial Cystsrare and benign lesions/etiology controversialPathologic studie

16、s ependymal in origin spherical to ovoid, measure up to several centimeters in size, and may have mass effectthe lateral ventricles or fourth ventricle/the cerebral hemispheres, thalamus,midbrain, pons and cerebellarvermis ,the medial temporal lobe in or near the choroidal fissureby pathologic study

17、Neuroepithelial cyst of the thalamusin a 53-year-old woman with migraineheadachesNeuroepithelial cyst of the cerebral peduncle and pons in a 60-year-old womanwith epilepsyChoroidal fissure cyst in a1-week-old boyConclusionsVR spaces surround the walls of arteries, arterioles, veins, and venules as they course from the subarachnoid space through the brain parenchymaSmall VR spaces (2 mm)Visually, the signal intensities of the VR spaces are identical to those of CSF with all pulse sequencesDilated VR spaces typically occur in three characteristic locationsOccasionally, VR spa