腦血管VR間隙的MRI診療和鑒別診療培訓(xùn)課件

1、概述血管周?chē)g隙，也稱(chēng)為Virchow-Robin Spaces（VRS）VRS將血管與周?chē)哪X組織分離開(kāi)來(lái)，是腦實(shí)質(zhì)內(nèi)間質(zhì)液體等引流的通道，具有一定的生理和免疫功能VRS增多和擴(kuò)大見(jiàn)于老年腦、高血壓、糖尿病、癡呆、腦白質(zhì)病變、腦積水、多發(fā)性硬化、中樞神經(jīng)隱球菌感染、兒童腦發(fā)育性疾MRI能清楚VRS，同時(shí)易誤診為其它病變10/5/20221腦血管VR間隙的MRI診療和鑒別診療概述血管周?chē)g隙，也稱(chēng)為Virchow-Robin Spac解剖大腦半球的VRS與蛛網(wǎng)膜下腔并不直接相通VRS與軟腦膜下腔接續(xù)的,是軟腦膜隨著穿通動(dòng)脈和流出靜脈進(jìn)出腦實(shí)質(zhì)的延續(xù)外界是神經(jīng)膠質(zhì)界膜，內(nèi)界是血管外層，最后，膠質(zhì)

2、界膜與血管外層融合成盲端在大腦半球，VRS是由單層軟膜構(gòu)成，在紋狀體動(dòng)脈周?chē)怯呻p層軟膜構(gòu)成VRS常常很小，直徑約1-2mm10/5/20222腦血管VR間隙的MRI診療和鑒別診療解剖大腦半球的VRS與蛛網(wǎng)膜下腔并不直接相通10/3/20210/5/20223腦血管VR間隙的MRI診療和鑒別診療10/3/20223腦血管VR間隙的MRI診療和鑒別診療生理VRS內(nèi)充滿組織間液,而不是腦脊液生理意義是作為腦組織間液排出的一個(gè)主要通路同時(shí)也提供了外來(lái)抗原進(jìn)入腦、細(xì)胞間液和腦脊液的機(jī)會(huì)10/5/20224腦血管VR間隙的MRI診療和鑒別診療生理VRS內(nèi)充滿組織間液,而不是腦脊液10/3/20224腦V

3、RS擴(kuò)大一般認(rèn)為，2mm被認(rèn)為是VRS擴(kuò)大擴(kuò)大的VRS的特征是邊界光滑清楚，呈圓形或管狀（由于部位和切面不同），與穿通動(dòng)脈的行徑相一致擴(kuò)大的VRS與年齡、高血壓、癡呆、伴隨的白質(zhì)病變等有關(guān)10/5/20225腦血管VR間隙的MRI診療和鑒別診療VRS擴(kuò)大一般認(rèn)為，2mm的VRS屬正常解剖結(jié)構(gòu)，可見(jiàn)于各VRS擴(kuò)大的機(jī)制動(dòng)脈壁通透性增高腦脊液引流障礙引起的液體積聚血管迂曲和腦萎縮導(dǎo)致的細(xì)胞外水分的積聚：老年腦（VRS與年齡明顯相關(guān)）組織間液經(jīng)腦實(shí)質(zhì)內(nèi)小孔從細(xì)胞外向微血管周?chē)浤X膜下間隙逐漸滲漏VRS纖維化和閉塞以及由此引起的液體流動(dòng)阻力增加10/5/20226腦血管VR間隙的MRI診療和鑒別診療V

4、RS擴(kuò)大的機(jī)制動(dòng)脈壁通透性增高10/3/20226腦血管VVRS的MRI表現(xiàn)信號(hào)特點(diǎn)各序列上均與腦脊液信號(hào)一致增強(qiáng)掃描無(wú)強(qiáng)化小的VR間隙(25 mm)周?chē)X實(shí)質(zhì)通常無(wú)異常信號(hào)改變形態(tài)特點(diǎn)圓形或橢圓形或者管狀，無(wú)占位效應(yīng)邊界清楚、光滑 ，通常為雙側(cè)大小一般小于5mm10/5/20227腦血管VR間隙的MRI診療和鑒別診療VRS的MRI表現(xiàn)信號(hào)特點(diǎn)10/3/20227腦血管VR間隙位置及分型I型（基底節(jié)型）：沿著豆紋動(dòng)脈分布于基底節(jié)區(qū)周?chē)ず送庀虏亢屯饽蚁虏?，常位于通常位于基底?jié)區(qū)的下1/3）II型（大腦半球型）：沿著髓質(zhì)穿支動(dòng)脈分布，分布于皮層下白質(zhì)（半卵圓中心、胼胝體和側(cè)腦室附近）III型（

5、中腦型）：隨著來(lái)自大腦后動(dòng)脈的穿通動(dòng)脈進(jìn)入中腦，分布于中腦、橋腦中腦連接處10/5/20228腦血管VR間隙的MRI診療和鑒別診療位置及分型10/3/20228腦血管VR間隙的MRI診療和鑒Bilateral type I VR spaces in a 6-year-old boy10/5/20229腦血管VR間隙的MRI診療和鑒別診療Bilateral type I VR spaces in Bilateral type I VR spaces in a 53-year-old woman. 10/5/202210腦血管VR間隙的MRI診療和鑒別診療Bilateral type I VR s

6、paces in 10/5/202211腦血管VR間隙的MRI診療和鑒別診療10/3/202211腦血管VR間隙的MRI診療和鑒別診療Type II VR spaces in a 73-year-old womanType II dilated VR spaces in a 6-year-old boy.10/5/202212腦血管VR間隙的MRI診療和鑒別診療Type II VR spaces in a 73-yearType III VR space in a 25-year-old man. 10/5/202213腦血管VR間隙的MRI診療和鑒別診療Type III VR space i

7、n a 25-yearType III型10/5/202214腦血管VR間隙的MRI診療和鑒別診療Type III型10/3/202214腦血管VR間隙的MR不典型表現(xiàn)VRS偶可明顯增大，表現(xiàn)出占位效應(yīng)，類(lèi)似囊樣占位，F(xiàn)LARI序列上周?chē)X實(shí)質(zhì)內(nèi)見(jiàn)高信號(hào)影巨大的VRS常見(jiàn)于中腦-丘腦區(qū)域，可以壓迫第三腦室引起腦積水10/5/202215腦血管VR間隙的MRI診療和鑒別診療不典型表現(xiàn)VRS偶可明顯增大，表現(xiàn)出占位效應(yīng)，類(lèi)似囊樣占位， Giant VR spaces in the mesencephalothalamic region in a 19-year-old man10/5/202216

8、腦血管VR間隙的MRI診療和鑒別診療 Giant VR spaces in the mese large VR spaceFollow up in 3 years10/5/202217腦血管VR間隙的MRI診療和鑒別診療 large VR spaceFollow up in 3 10/5/202218腦血管VR間隙的MRI診療和鑒別診療10/3/202218腦血管VR間隙的MRI診療和鑒別診療 Differential Diagnosislacunar infarctions -腔隙性腦梗塞cystic periventricular leukomalacia-腦室周?chē)踪|(zhì)軟化multiple

9、 sclerosis-多發(fā)性硬化cryptococcosis-腦隱球菌病cystic neoplasmsneurocysticercosis-腦囊蟲(chóng)病arachnoid cysts-蛛網(wǎng)膜囊腫neuroepithelial cysts-神經(jīng)上皮囊腫10/5/202219腦血管VR間隙的MRI診療和鑒別診療 Differential Diagnosislacun1.腔隙性腦梗死急性期T1低信號(hào)，T2高信號(hào)，F(xiàn)LAIR高信號(hào)慢性期病灶FLAIR上表現(xiàn)為中心低信號(hào)，周?chē)咝盘?hào)環(huán)繞，提示膠質(zhì)增生可有強(qiáng)化（亞急性期）10/5/202220腦血管VR間隙的MRI診療和鑒別診療1.腔隙性腦梗死急性期T1低信

10、號(hào)，T2高信號(hào)，F(xiàn)LAIR高信腔隙性腦梗死10/5/202221腦血管VR間隙的MRI診療和鑒別診療腔隙性腦梗死10/3/202221腦血管VR間隙的MRI診療Acute and chronic lacunar infarctions in a 66-year-old man10/5/202222腦血管VR間隙的MRI診療和鑒別診療Acute and chronic lacunar infa2.囊性腦室周?chē)踪|(zhì)軟化常見(jiàn)于未發(fā)育成熟的嬰幼兒，常有腦缺血史雙側(cè)腦室三角區(qū)附近最常見(jiàn)，F(xiàn)LAIR上周?chē)梢?jiàn)高信號(hào)改變常對(duì)稱(chēng)分布周?chē)X室可代償性增寬可伴有胼胝體發(fā)育不良10/5/202223腦血管VR間隙的

11、MRI診療和鑒別診療2.囊性腦室周?chē)踪|(zhì)軟化常見(jiàn)于未發(fā)育成熟的嬰幼兒，常有腦缺血 Cystic periventricular leukomalacia in a 3-year-old boy with a history of perinatal asphyxia who had delayed motor and mental development and epilepsy. 10/5/202224腦血管VR間隙的MRI診療和鑒別診療 Cystic periventricular leu3. 多發(fā)性硬化與側(cè)腦室呈垂直分布 (Dawson Fingers) 信號(hào)特點(diǎn)T1WI 等或稍低 急性

12、期 中央低信號(hào)，周?chē)噬愿咝盘?hào)環(huán) 慢性期T2WI and FLAIR高信號(hào)增強(qiáng)掃描可見(jiàn)強(qiáng)化10/5/202225腦血管VR間隙的MRI診療和鑒別診療3. 多發(fā)性硬化與側(cè)腦室呈垂直分布 (Dawson Fing Ovoid MS lesion of the centrum semiovale in a 49-year-old man10/5/202226腦血管VR間隙的MRI診療和鑒別診療 Ovoid MS lesion of the cent4. 腦隱球菌病新型隱球菌引起的機(jī)會(huì)性感染，見(jiàn)于免疫功能缺陷或使用免疫抑制劑患者好發(fā)于顱底，通常引起輕度的炎癥反應(yīng)，常伴有腦膜感染影像學(xué)上常表現(xiàn)為腦膜炎，

13、腦膜急性滲出和腦膜粘連引起的腦水腫基底節(jié)區(qū)/丘腦和中腦的小斑點(diǎn)狀高信號(hào)，F(xiàn)LAIR表現(xiàn)為高信號(hào)有助于鑒別一般沒(méi)有強(qiáng)化，DWI可以表現(xiàn)為高信號(hào)10/5/202227腦血管VR間隙的MRI診療和鑒別診療4. 腦隱球菌病新型隱球菌引起的機(jī)會(huì)性感染，見(jiàn)于免疫功能缺陷5. 囊性腫瘤常呈囊實(shí)性常有瘤周水腫信號(hào)常與腦脊液不一致 可見(jiàn)強(qiáng)化典型的部位及信號(hào)特點(diǎn)腫瘤VR spacepilocytic astrocytomahemangioblastoma10/5/202228腦血管VR間隙的MRI診療和鑒別診療5. 囊性腫瘤常呈囊實(shí)性典型的部位及信號(hào)特點(diǎn)腫瘤VR spa pilocytic astrocytoma

14、 of the right thalamus, cerebral peduncle in a 15-year-old girl10/5/202229腦血管VR間隙的MRI診療和鑒別診療 pilocytic astrocytoma of th6.腦囊蟲(chóng)病顱內(nèi)最常見(jiàn)的寄生蟲(chóng)感染典型者卵圓形含液囊腫內(nèi)可見(jiàn)頭節(jié)常見(jiàn)于灰白致交界處10/5/202230腦血管VR間隙的MRI診療和鑒別診療6.腦囊蟲(chóng)病顱內(nèi)最常見(jiàn)的寄生蟲(chóng)感染10/3/202230腦血MRI表現(xiàn)早期囊泡期囊性腫塊，各序列上與腦脊液相似 中央可見(jiàn)偏心性頭節(jié) (hyperintense to CSF) 通常無(wú)強(qiáng)化膠質(zhì)囊泡期較腦脊液信號(hào)增高；可見(jiàn)瘤

15、周水腫及強(qiáng)化肉芽腫結(jié)節(jié)期 囊壁明顯增厚；結(jié)節(jié)或環(huán)形強(qiáng)化 瘤周水腫減輕結(jié)節(jié)鈣化期病灶萎縮、較小，完全鈣化 10/5/202231腦血管VR間隙的MRI診療和鑒別診療MRI表現(xiàn)早期囊泡期10/3/202231腦血管VR間隙的M10/5/202232腦血管VR間隙的MRI診療和鑒別診療10/3/202232腦血管VR間隙的MRI診療和鑒別診療7. 蛛網(wǎng)膜囊腫 好發(fā)于中顱窩 、鞍上池較明顯的占位效應(yīng)鑒別主要依據(jù)部位Arachnoid cyst in the perisellar cistern area in a 16-year-old girl10/5/202233腦血管VR間隙的MRI診療和鑒別診

16、療7. 蛛網(wǎng)膜囊腫 好發(fā)于中顱窩 、鞍上池Arachnoid 8. 神經(jīng)上皮囊腫可有占位效應(yīng)各序列上均與腦脊液相似，周?chē)鸁o(wú)膠質(zhì)增生無(wú)強(qiáng)化鑒別通常較困難10/5/202234腦血管VR間隙的MRI診療和鑒別診療8. 神經(jīng)上皮囊腫可有占位效應(yīng)10/3/202234腦血管V Neuroepithelial cyst of the cerebral peduncle and pons in a 60-year-old woman with epilepsy. 10/5/202235腦血管VR間隙的MRI診療和鑒別診療 Neuroepithelial cyst of the脈絡(luò)膜裂囊腫常位于海馬回與下丘腦之間，內(nèi)側(cè)通于環(huán)池，外側(cè)為側(cè)腦室下角，前面是海馬溝及杏仁體，后部與海馬溝交通與腦脊液信號(hào)相仿冠狀位上多呈“雙凸透鏡”形，顯示最好矢狀位上，脈絡(luò)膜裂與海馬溝交通，類(lèi)似斜臥的入”字，其長(zhǎng)軸沿后上至前下斜行為特征性結(jié)構(gòu)10/5/202236腦血管VR間隙的MRI診療和鑒別診療脈絡(luò)膜裂囊腫