耶，鄭版也來了。學(xué)習(xí)了。
剛剛查了一篇文獻(xiàn)似乎和鄭版說的不同。
血管造影是CVM的最佳診斷方法,其典型表現(xiàn)是在靜脈期中出現(xiàn)許多細(xì)小擴(kuò)張的髓靜脈呈放射狀匯入一條或多條粗
大的引流靜脈。后者通常經(jīng)表淺的皮層靜脈進(jìn)入靜脈竇,或向深部進(jìn)入深靜脈系統(tǒng),表現(xiàn)為“水母頭”征,或稱為“傘狀”,“車輻狀”,“星簇狀”改變。在靜脈早期出現(xiàn),持續(xù)到靜脈晚期,髓靜脈在靜脈中期顯示最清。Yasargi總結(jié)了CVM的診斷標(biāo)準(zhǔn):1、缺乏供血?jiǎng)用};2、病灶出現(xiàn)在靜脈期;3、許多細(xì)小擴(kuò)張的髓靜脈;4、經(jīng)擴(kuò)張的腦貫穿靜脈(表淺型)或室管膜下靜脈(深部型)引流。根據(jù)髓靜脈的部位CVM分為:1、皮層表淺型,引流入淺靜脈系統(tǒng)或淺深靜脈同時(shí)引流;2、皮層下型,引流入深靜脈系統(tǒng)或深淺靜脈同時(shí)引流;3、腦室旁型,引流入室管膜下深靜脈系統(tǒng)。根據(jù)引流靜脈的類型分為表淺型和深部型。幕上淺型經(jīng)皮層靜脈進(jìn)入靜脈竇,幕上深型注入側(cè)腦室上外側(cè)角的
室管膜下靜脈。幕下淺型向小腦蚓靜脈或小腦表面靜脈引流。幕下深型向第四腦室側(cè)隱窩靜脈,前中央靜脈或橋橫靜脈引流[3]。
點(diǎn)擊下載

又來了。

Clinical Examination. This 32-year-old previously healthy
right-handed man was admitted to our hospital because of
a headache that had occurred suddenly. He had no stroke
risk factor. Initially, he presented with increasing intensity
of headache and vomiting. His initial Glasgow Coma Scale
score was 14. Results of the remainder of a general physical
examination were unremarkable. Several hours after admission,
the patient’s headaches worsened and he suffered
several more bouts of emesis. His level of consciousness
deteriorated rapidly and he was intubated (Glasgow Coma
Scale score 7 of 15).
Radiological Findings. The initial unenhanced CT scan
exhibited a spontaneous curvilinear and tubular hyperdensity
located on the left middle cerebellar peduncle in the vicinity
of the fourth ventricle, which later proved to be the
thrombus in the venous angioma collector (Fig. 1 left and
center). There was no mass effect. After the patient’s condition
worsened, another CT scan revealed acute obstructive
hydrocephalus (Fig. 1 right). An MR image of the brain
demonstrated an extensive ischemic lesion located on the
pons, the mesencephalus, the cerebellum culmen, and the
middle and superior left cerebellar peduncles (Fig. 2). There
was no coexisting cavernous angioma. In addition, MR imaging
studies clearly revealed the typical “caput medusae”
appearance of the left cerebellum venous angioma (Fig. 3).
Results of cerebral angiography on Day 2 postadmission
were normal.
Laboratory Studies. Antithrombin III, protein C, and protein
S levels were normal. There was no activated protein
C resistance or factor V Leiden mutation. Antiphospholipid
antibodies were not detected. Results of the other routine
laboratory tests were also normal.

FIG. 1. Left and Center: Unenhanced CT scans obtained at the level of the pons, demonstrating a tubular, high-density
structure corresponding to the clot in the draining vein of the venous angioma. This malformation was located deep in
the left middle cerebellar peduncle in the vicinity of the fourth ventricle. Right: Unenhanced CT scan obtained after the
patient’s condition had worsened, revealing a secondary obstructive hydrocephalus.


FIG. 2. Axial T2-weighted MR images at the level of the pons
exhibiting a high signal intensity corresponding to the nonhemorrhagic
subcortical infarction of the vermis and left cerebellum. The
tubular hypointensity and round shape correspond to the clot in the
draining vein (arrows).


FIG. 3. Axial three-dimensional spoiled gradient–recalled acquisition
MR sequence revealing the venous angioma with its typical
caput medusae appearance resulting from the convergence of small
veins (arrowheads) on a large, thrombosed draining vein.


FIG. 4. Axial T2-weighted MR images obtained at 1 month postadmission,
demonstrating partial resolution of the cerebellar infarct
and an area of high signal intensity related to an old clot in the draining
vein (arrows).


FIG. 5. Drawing of parasagittal section showing the location of
the patient’s venous angioma with its drainage vein (dv) and collector
trunk (ct). Other main veins of the posterior fossa that could
drain possible venous angiomas are also marked. Amv = anterior
medullary vein; apmv = anterior pontomesencephalic vein; irtv =
inferior retrotonsillar vein; ivv = inferior vermian vein; lbv = lateral
brachial vein; pcev = precentral vein; pcuv = preculminate vein;
psv = posterior spinal vein; pv = petrosal vein; srtv = superior retrotonsillar
vein; svv = superior vermian vein; tpv = transverse pontine
vein; vlr = vein of lateral recess of fourth ventricle.

再來一個(gè)！

好帖，精彩。
來一個(gè)更加精彩的，CT診斷靜脈畸形。

Fig. 1. a., b. Brain CT without IV contrast administration showing hyperdense hematoma (large arrow) in the left high frontal lobe, interspersed with multiple small punctate-like calcifications (small arrows). Moderate-degree perifocal edema can also be noted (arrowheads). c., d. Post-contrast CT at the same anatomic levels showing abnormal contrast-opacified vasculature (large arrowheads).



Fig. 2. Left common carotid digital subtraction cerebral angiograms: A-C (frontal projection, in early arterial, late arterial, and venous phases, respectively), D-F (lateral projection, in early arterial, late arterial, and venous phases, respectively) showing the paradoxical dilated left ACA and MCA (small black arrows), the nidus of AVM (large black arrows), the draining vein of AVM (large white arrows, the descending limb; long thin white arrows, the ascending limb), the umbrella-like venous malformation and its stem vein (large white arrowheads), the engorged cortical draining vein (small white arrows), and the deep draining vein of the venous malformation (small white arrowheads) which drains to the internal cerebral vein (black arrowheads). It is worth noting that in the frontal projection, the ascending limb of the draining vein of the AVM was superimposed over the stem vein of the venous malformation (hollow arrow).

Picture 1. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image obtained in a patient who had undergone surgery in the past for an arteriovenous malformation (AVM) shows bilateral developmental venous anomalies (DVAs) and the classic caput medusa appearance. Note the signal intensity abnormality in the inferior right cerebellar hemisphere due to the prior surgery.


Picture 2. Brain, venous vascular malformation. Coronal T1-weighted contrast-enhanced image clearly shows the draining vein and associated venous network of a developmental venous anomaly (DVA).


Picture 3. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as image 2 demonstrates the high signal intensity of the draining vein, which is typical on images obtained with this sequence. Note the yin-yang appearance of the vessel with an area of decreased signal intensity adjacent to the area with increased signal intensity

Picture 4. Brain, venous vascular malformation. Axial proton density–weighted image in the same patient as Image 2 and Image 3 shows an area of marked signal intensity loss in the right cerebellum adjacent to the developmental venous anomaly (DVA). This finding is consistent with a coexistent cavernous angioma.


Picture 5. Brain, venous vascular malformation. Coronal T1 postcontrast demonstrates a typical location for a DVA, here within the periventricular white matter. This malformation drained into a cortical vein along the parietal convexity.


Picture 6. Brain, venous vascular malformation. Axial postcontrast image from the same patient as in Image 5 demonstrates the fine network of feeder veins that converge into the single draining vein.

Picture 7. Brain, venous vascular malformation. Axial T2 image from same patient as Images 5 and 6 shows that the DVA can be subtle. In this patient, the draining vein is large enough to have a flow void on the image. The parenchymal abnormality is typically not visible.


Picture 8. Brain, venous vascular malformation. Axial fluid-attenuated inversion recovery shows some artifactual increased signal within the vessel, which can aid in detection of DVAs on noncontrasted studies.


Picture 9. Brain, venous vascular malformation. On fast low-angle shot images, both the venous cluster and the draining vein may have mild susceptibility artifact (although not as much as hemosiderin) secondary to the deoxyhemoglobin within the slow-flowing veins (arrows).

Picture 10. Brain, venous vascular malformation. Axial T1 postcontrast demonstrates a large DVA originating from the frontal lobe white matter. Note the cluster of small vessels that form the large draining vein.


Picture 11. Brain, venous vascular malformation. Slightly higher image in the same patient as Image 10. The large draining vein is noted to drain into the superior sagittal sinus

高樂高！

想看看在TCD方面有沒有什么依據(jù)？