Karotis diseksiyonu BT bulguları

Özet

Ekstrakraniyal ICA diseksiyonu intimal yırtık veya primer duvar içi hematom sonrası gelişebilir; subintimal hematom lümende darlık ya da oklüzyona, ayrıca distal tromboemboliye yol açabilir. Baş-boyun BTA hızlı biçimde uzun tapering daralmayı, eksantrik mural kalınlaşmayı, intimal flebi, çift lümeni ve diseksiyon psödoanevrizmasını gösterebilir. CTA'da mural hematom her zaman doğrudan seçilmeyebilir; tanı lümen biçimi, damar dış çapı ve duvar bulgularının birlikte değerlendirilmesine dayanır. Diseksiyonda lümen darlığının derecesi, oklüzyon, diseksiyon yerindeki intralüminal trombüs ve intrakraniyal uzanım değerlendirilmesi gereken temel faktörlerdir.

Faz ve pencere

BTA tanısal: Baş-boyun BTA'da servikal ICA'da alev biçimli tapering lümen daralması veya oklüzyon, intimal flep, çift lümen ve diseksiyon psödoanevrizması bulguları değerlendirilir.
Kontrastsız: Diseksiyon değerlendirmesinde ilk basamak noninvaziv görüntüleme yöntemleri CTA veya yağ baskılı MRI/MRA'dır. CTA lümen daralması, flep ve psödoanevrizmayı değerlendirmek için kullanılır; mural hematom şüphesi sürüyorsa yağ baskılı T1 MRA ek bilgi sağlayabilir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Yumuşak doku (G 400 / M 40).

BT bulguları

Flame-shaped tapering — ICA lümeninin uzun segmentte düzgün ve giderek incelerek sonlanması; ani kısa aterosklerotik bulb darlığından farklıdır.
Duvar içi hematom, lümen daralmasıyla birlikte veya onsuz görülebilir ve damar dış çapında genişlemeye eşlik edebilir.
Mural hematom, yağ baskılı T1 ağırlıklı MRG'de hilal biçimli hiperintensite olarak görülebilir. Diseksiyon değerlendirmesinde mural hematomu göstermek için yağ baskılı MRG kullanılabilir.
İntimal flep — opak damar lümeni içinde duvar tabakalarını ayıran ince çizgi; gerçek flep iki dik düzlemde izlenebilir.
Çift lümen — kontrastlı gerçek ve yalancı lümenin ayrıldığı çizgisel membran veya iki ayrı opasifiye kanal.
Diseksiyon psödoanevrizması — stenozlu segmentle ilişkili fokal dışa doğru sakküler genişleme; boyun ve kafa tabanı yönündeki devamlılığı belirlenir.
Diseksiyona bağlı oklüzyon, alev biçimli kontrast taperingi ve lümen daralmasıyla birlikte görülebilir.
Diseksiyon distal tromboemboliye ve embolik iskemik inmeye yol açabilir; eşlik eden iskemi MRI ile değerlendirilebilir.

Ölçütler ve sınıflamalar

Biffl/Denver damar yaralanması derecelendirmesi: Biffl derecelendirmesi, künt serebrovasküler yaralanmalarda minimal intimal hasar, diseksiyon, intramural hematom, psödoanevrizma, oklüzyon, transeksiyon ve arteriyovenöz fistül gibi damar yaralanmalarını sınıflandırır. Bu derecelendirme, künt travmaya bağlı serebrovasküler yaralanmaların sınıflandırılması bağlamındadır.

Normalde

CTA'da servikal ICA'da alev biçimli kontrast taperingi ve yalancı lümen diseksiyon bulguları arasındadır.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0622; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Aterosklerotik ICA stenozu: çoğunlukla bulbda fokal eksantrik plak ve kalsifikasyon yapar; diseksiyonda distal servikal segmentte uzun tapering ve mural değişiklik öne çıkar.
Near-occlusion, ciddi ICA stenozuna bağlı distal ICA çapında azalma ile tanımlanır.
Karotis fibromüsküler displazisi: distal ICA'da çok odaklı daralma-genişleme dizisi ve boncuklanma görünümü vardır; tipik tek uzun hematomlu tapering segment değildir.
Konjenital ICA hipoplazisi nadir bir vasküler anomalidir ve görüntülemede edinsel damar hastalığından ayırt edilmelidir.
Akut serbest yüzen trombüs: lümen içinde duvara tutunan dolum defekti ve çevresel kontrast akımı görülür; damar duvarında ayrışan flep göstermez.

Tuzaklar

CTA'da intimal flep ve yalancı lümen diseksiyon bulguları arasında değerlendirilir; CTA, intimal flepleri saptamada MRA'dan üstündür.
Servikal ICA oklüzyonunda CTA'da kontrastla dolu lümenin biçimi, kenarları ve yeri etiyolojiyi ayırt etmeye yardımcı olabilir.
Near-occlusion, ciddi ICA stenozuna bağlı distal ICA çapında azalma ile tanımlanır.
CTA'da mural hematom doğrudan belirgin olmayabilir; duvar içi hematom görülmemesini diseksiyonu dışlayan bulgu kabul etmeyin ve dar eksantrik lümen/dış çap asimetrisini inceleyin.

Kendini dene

BTA'da servikal ICA'da alev biçimli kontrast taperingi ve intimal flep görülüyor. En olası tanı nedir?
Cevabı göster
Karotis diseksiyonu. Alev biçimli kontrast taperingi ve intimal flep, karotis diseksiyonunu destekleyen görüntüleme bulgularıdır.
Ciddi ICA stenozunu izleyen distal ICA çapında azalma hangi durumu tanımlar?
Cevabı göster
Near-occlusion. Near-occlusion, ciddi ICA stenozunun distal ICA çapında azalmaya yol açmasıyla tanımlanır.

İlgili konular

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 25 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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