Sakküler intrakraniyal anevrizma BT bulguları

Özet

Sakküler anevrizma, çoğunlukla intrakraniyal arterlerin dallanma çevresinde gelişen kese biçimli duvar çıkıntısıdır. Rüptür subaraknoid kanamaya yol açabilir; BT anjiyografi anevrizmanın yerini, şeklini ve komşu dallarla ilişkisini hızlı biçimde gösterir. Kontrastsız baş BT'si eşlik eden akut kanamanın dağılımını araştırır, ancak küçük veya kanamamış anevrizmayı dışlamak için yeterli değildir. Kese ile damar kıvrımı ya da infundibulumu karıştırmak takip ve raporlamayı değiştirir.

Faz ve pencere

Kontrastsız: Anevrizma lümeni rutin beyin BT'sinde güvenilir biçimde ayrıştırılmaz; akut rüptürde bazal sisternlerde, fissürlerde veya sulkuslarda hiperdens subaraknoid kan görülebilir.
BTA tanısal: Dallanma noktasına bağlı, ana arterle eş zamanlı kontrastlanan yuvarlak ya da lobüle kese; kaynak kesitler ve çok düzlemli rekonstrüksiyonlarda boyun, kubbe yönü ve çıkan dal bağlantısı gösterilir.

Önerilen pencereler: Beyin (G 80 / M 40), Anjiyo (G 600 / M 150), Kemik (G 1800 / M 400).

BT bulguları

Dallanma kesesi — ACom, ICA-PCom, MCA bifurkasyonu veya vertebrobaziler bileşke çevresinde ana lümen dışına uzanan kontrastlı çıkıntı.
Boyun ve kubbe — kesenin ana arterle birleştiği taban ile kubbenin baktığı yön ayrı ayrı izlenir.
Dal ilişkisi — PCom, anterior koroidal, lentikülostriat veya distal serebral dalın boyundan mı kubbeden mi çıktığı belirlenir.
Düzensiz kontur — lobülasyon veya kubbe çıkıntısı, düzgün eliptik bir damarsal genişlemeden farklı olarak kese duvarında odaksal düzensizlik gösterir.
Kalsifiye duvar — anevrizma çevresindeki kavisli kalsifikasyon kemik penceresinde seçilebilir; lümen sınırı için BTA kaynak görüntüleri kullanılır.
Rüptür kanaması — eşlik eden hiperdens kanın bazal sistern, interhemisferik fissür, Sylvian fissür ve ventriküllerdeki dağılımı not edilir.

Normalde

Normal Willis poligonunda ICA, ACA, MCA, PCA ve baziler arter lümenleri dallanma noktasında düzgün biçimde devam eder; arter duvarından ayrılan yuvarlak kontrast kesesi beklenmez. Şüpheli yapının infundibulumdan ayrımı için komşu dalın apeksinden çıkıp çıkmadığına, sakküler anevrizmada ise dalın kese boynuyla ilişkisine aksiyel kaynak görüntüler ve koronal rekonstrüksiyonlarda bakın.

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 s0103; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

İnfundibulum: konik genişlemenin tepesinden ince bir dal çıkar; bağımsız yuvarlak kubbe ve belirgin boyun yoktur.
Damar kıvrımı: tek projeksiyonlu görüntülerde hacim algısı eksik olabilir ve komşu damar örtüşmeleri anevrizma tespitini zorlaştırır.
Fuziform genişleme: arterin uzun bir segmenti çevresel olarak genişler; tek bir dallanma kesesi görünümü yoktur.
Blister anevrizma: supraklinoid ICA'nın dallanmayan duvarında sığ, geniş tabanlı çıkıntı yapar.
Kalsifiye plak: damar duvarı boyunca eksantrik kalsifikasyon ve lümen düzensizliği vardır; arter dışına uzanan opak kese bulunmaz.

Tuzaklar

PCom infundibulumu küçük anevrizma sanılabilir; ince PCom dalını kesenin tepesine kadar takip edin.
Kafa tabanı kemik örtüşmesi paraklinoid ICA konturunu gizleyebilir; kemik çıkarımlı görünümle yetinmeyip kaynak kesit ve multiplanar görüntüyü kontrol edin.
Tek projeksiyonlu görüntüler hacim algısını sağlamaz ve komşu damarların örtüşmesi anevrizmanın görülmesini zorlaştırabilir; şüpheli konturu kaynak kesitlerde değerlendirin.
Negatif BTA, özellikle küçük blister lezyonu veya yoğun kanama şüphesini tamamen dışlamaz; kanama dağılımı ile damar odağının yer uyumunu gözden kaçırmayın.

Kendini dene

Anjiyografide serebral damardan kese biçiminde dışa uzanan, boynu ve ana damarla ilişkisi seçilebilen yapı görülüyor. En olası tanı nedir?
Cevabı göster
Sakküler anevrizma. Sakküler anevrizmalar, arter duvarındaki iç elastik lamina ve tunika media defektinden dışa doğru uzanan, radyo-opak ve düzgün kenarlı kese biçimli çıkıntılardır.
Kontrastsız BT'de subaraknoid kanamanın üç ana dağılım paterni hangileridir?
Cevabı göster
Yaygın, mezensefal çevresi ve konveksal. Subaraknoid kanama kontrastsız BT'deki kan dağılımına göre yaygın, mezensefal çevresi ve konveksal olmak üzere üç ana paternde sınıflandırılır.

İlgili konular

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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