静脉畸形
静脉畸形的水母征或者叫海蛇头征，其DSA诊断要点：放射状扩张的髓静脉和粗的的引流静脉在晚期出现，显影时间延长。
血管造影是CVM的最佳诊断方法,其典型表现是在静脉期中出现许多细小扩张的髓静脉呈放射状汇入一条或多条粗大的引流静脉。后者通常经表浅的皮层静脉进入静脉窦,或向深部进入深静脉系统,表现为“水母头”征,或称为“伞状”,“车辐状”,“星簇状”改变。在静脉早期出现,持续到静脉晚期,髓静脉在静脉中期显示最清。Yasargi总结了CVM的诊断标准:1、缺乏供血动脉;2、病灶出现在静脉期;3、许多细小扩张的髓静脉;4、经扩张的脑贯穿静脉(表浅型)或室管膜下静脉(深部型)引流。根据髓静脉的部位CVM分为:1、皮层表浅型,引流入浅静脉系统或浅深静脉同时引流;2、皮层下型,引流入深静脉系统或深浅静脉同时引流;3、脑室旁型,引流入室管膜下深静脉系统。根据引流静脉的类型分为表浅型和深部型。幕上浅型经皮层静脉进入静脉窦,幕上深型注入侧脑室上外侧角的室管膜下静脉。幕下浅型向小脑蚓静脉或小脑表面静脉引流。幕下深型向第四脑室侧隐窝静脉,前中央静脉或桥横静脉引流。
女性，53岁，主因“突发额颞部胀痛3天”急诊以“脑室出血”于－02－04收入院。
血管畸形的分类：
AVM
静脉畸形（静脉瘤）
海绵状血管瘤
毛细血管扩张症
另一例：
又一例
FIG1.A,NoncontrastaxialCTscanshowsanisoattenuatedextraaxiallesionanteriortotherighttemporalpole.B,Contrast-enhancedaxialCTscanshowsintenseenhancementofthelesion.C,Contrast-enhancedaxialCTscanshowsmultiplesubependymalveinsjoiningtoformcollectorveinsunifyingintoatortuouschannelintheregionoftherightsylvianfissureandcontinuingtotheregionoftheanteriortemporalenhancingextraaxiallesion.Abnormalenhancingvesselsarealsoseenintheleftfrontalregion.
FIG2.A,-B,Rightandleftinternalcarotidarteryangiogramsshowanormalarterialphase.
FIG3.A,-B,Anteroposteriorviewofearlyandlatevenousphasesoftherightinternalcarotidarteryangiogramsshowsthepresenceof2varicesandthevenousangioma.
FIG4.Lateralviewofthevenousphaseoftherightinternalcarotidarteryangiogramshowsaclassic“Medusahead”appearancewithadrainingveinvarixintheregionoftherightsuperficialmiddlecerebralvein
FIG5.Lateralviewofthevenousphaseoftheleftinternalcarotidarteryangiogramshowsaclassic“Medusahead”appearancedrainingintothesuperiorsagittalsinus.
其实MR+C对发育性静脉畸形诊断价值极高
FIG.1.LeftandCenter:UnenhancedCTscansobtainedatthelevelofthepons,demonstratingatubular,high-densitystructurecorrespondingtotheclotinthedrainingveinofthevenousangioma.Thismalformationwaslocateddeepintheleftmiddlecerebellarpeduncleinthevicinityofthefourthventricle.Right:UnenhancedCTscanobtainedafterthepatient’sconditionhadworsened,revealingasecondaryobstructivehydrocephalus.FIG.2.AxialT2-weightedMRimagesattheleveloftheponsexhibitingahighsignalintensitycorrespondingtothenonhemorrhagicsubcorticalinfarctionofthevermisandleftcerebellum.Thetubularhypointensityandroundshapecorrespondtotheclotinthedrainingvein(arrows).FIG.3.Axialthree-dimensionalspoiledgradient–recalledacquisitionMRsequencerevealingthevenousangiomawithitstypicalcaputmedusaeappearanceresultingfromtheconvergenceofsmallveins(arrowheads)onalarge,thromboseddrainingvein.FIG.4.AxialT2-weightedMRimagesobtainedat1monthpostadmission,demonstratingpartialresolutionofthecerebellarinfarctndanareaofhighsignalintensityrelatedtoanoldclotinthedrainingvein.(arrows)
FIG.5.Drawingofparasagittalsectionshowingthelocationofthepatient’svenousangiomawithitsdrainagevein(dv)andcollectortrunk(ct).Othermainveinsoftheposteriorfossathatcoulddrainpossiblevenousangiomasarealsomarked.Amv=anteriormedullaryvein;apmv=anteriorpontomesencephalicvein;irtv=inferiorretrotonsillarvein;ivv=inferiorvermianvein;lbv=lateralbrachialvein;pcev=precentralvein;pcuv=preculminatevein;psv=posteriorspinalvein;pv=petrosalvein;srtv=superiorretrotonsillarvein;svv=superiorvermianvein;tpv=transversepontinevein;vlr=veinoflateralrecessoffourthventricle.
CT诊断静脉畸形
Fig.1.a.,b.BrainCTwithoutIVcontrastadministrationshowinghyperdensehematoma(largearrow)inthelefthighfrontallobe,interspersedwithmultiplesmallpunctate-likecalcifications(smallarrows).Moderate-degreeperifocaledemacanalsobenoted(arrowheads).c.,d.Post-contrastCTatthesameanatomiclevelsshowingabnormalcontrast-opacifiedvasculature(largearrowheads).
Fig.2.Left
