İntrakraniyal aterosklerotik stenoz

Özet

İntrakraniyal aterosklerotik stenoz, büyük beyin arterlerinde aterom plağının lümeni daraltmasıdır ve geçici iskemik atak ya da iskemik inmenin tedavi edilebilir nedenlerinden biridir. Kontrastsız BT akut kanamayı ve gelişmiş infarktı tarar; BTA fokal lümen daralmasını, tıkanmayı, distal akımı ve kalsifiye plağı hızlı biçimde gösterir. Stenozun yüzdesi ölçüm yöntemine bağlıdır ve CTA'da kemik/kalsifikasyon artefaktı lümeni olduğundan dar gösterebilir; damar duvarı etiyolojisini her zaman tek başına belirleyemez. Kritik darlığın veya distal perfüzyon etkisinin atlanması inme mekanizmasını ve riskli damar bölgesini yanlış sınıflandırabilir.

Faz ve pencere

Kontrastsız

Akut kanama ve gelişmiş infarkt için beyin parankimi değerlendirilir; arter duvarındaki kalsifikasyon kavernöz ICA veya baziler arter boyunca çizgisel/odaksal hiperdens görünür. İntrakraniyal arter stenozunu değerlendirmede CTA etkili bir görüntüleme yöntemidir.

BTA tanısal

Arteriyel opasifikasyonda kavernöz/supraclinoid ICA, M1 MCA veya vertebrobaziler sistemde kısa segmentli fokal lümen daralması, düzensiz kontur ve distal dolum azalması aranır; kalsifik plak lümen kenarını örtebilir. İnce kesit kaynak görüntüler, multiplanar reformasyon ve karşı/komşu normal segment referansı birlikte kullanılır.

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

BT bulguları

• Fokal lümen daralması — arterin kısa segmentinde çevre normal segmente göre çap azalması; stenoz derecesi belirtilirken kullanılan yöntemi yazın.
• Düzensiz veya eksantrik kontur — aterosklerotik plakla uyumludur, ancak yalnız lümen görünümü etiyolojiyi kesinleştirmez.
• İntrakraniyal arter kalsifikasyonu — kavernöz ICA'da yoğun, duvar boyunca plak; kalın kümeli intimal kalsifikasyon ateromla ilişkili olabilir.
• Distal kontrast dolum azalması veya gecikmesi — darlık sonrası akım etkisini gösterir ve kollateral dolaşım ile birlikte yorumlanır.
• Tam tıkanma ve distal yeniden dolum — lümen sürekliliğinin kesilmesi ardından distal arterin kollaterallerle opasifiye olması görülebilir.
• İlgili arter alanında hipodens infarkt — MCA, ACA veya posterior dolaşım bölgesinde akut/subakut iskemiyle uyumlu parankim değişikliği.
• Sınır bölgesi infarktları — hemodinamik yetersizlikte arteriyel watershed dağılımda birden fazla küçük hipodens odak izlenebilir.

Ölçütler ve sınıflamalar

WASID çap stenozu hesabı

Yüzde stenoz = (1 − en dar lümen çapı / referans normal arter çapı) × 100

WASID stenoz ölçümü

Yüzde stenoz, en dar lümen çapının uygun normal referans çapına oranından hesaplanır. Önce darlığın proksimalindeki hastalıksız, en geniş, tortüöz olmayan ve paralel kenarlı segment seçilir; kullanılamıyorsa uygun distal ya da besleyici arter segmenti referans alınır.

Normalde

CTA, intrakraniyal arter stenozu ve oklüzyonunu saptamada etkili bir yöntemdir. WASID ölçümünde darlığın en yakın proksimalinde hastalık görmeyen, geniş ve düz seyirli arter segmenti referans çap olarak alınır; o segment de tutulmuşsa uygun distal veya yan dal segmenti tercih edilir. Kalsifiye duvarı lümen sanmayın ve distal dolumu ayrıca izleyin.

Ayırıcı tanı

İntrakraniyal arter diseksiyonu

uzun konik daralma, lümen düzensizliği veya yalancı lümen görülebilir; damar duvarı hematomu için MRI yardımcıdır.

Moyamoya hastalığı

terminal ICA ve proksimal dallarda ilerleyici daralma ile bazal kollateral damar ağı eşlik eder.

Vaskülit

birden fazla arterde segmental daralma ve düzensizlik olabilir; yalnız CTA lümen görünümü kesin etiyoloji vermez.

Vazospazm

özellikle subaraknoid kanama veya akut nörolojik olay çevresinde segmental daralma; zamana bağlı gerileme klinik bağlamı destekler.

İntrakraniyal emboli

ani lümen kesilmesi ve distal dal dolum kusuru ön plandadır; sabit duvar plağı/kalsifikasyonu olmayabilir.

Tuzaklar

• Kalsifikasyon blooming etkisiyle damar lümenini daraltabilir; kaynak kesitleri kemik penceresi ve farklı düzlem rekonstrüksiyonlarıyla birlikte kontrol edin.
• Hareket ve kontrast bolusu zamanlaması distal dolumu azaltıp yalancı stenoz veya tıkanma görünümü yaratabilir; komşu arterlerin opasifikasyonunu kıyaslayın.
• Stenoz yüzdesi için kullanılan ölçüm yöntemini tutarlı uygulayın; farklı ölçüm şemaları farklı sonuçlar verebilir.
• CTA'daki fokal daralma aterosklerozu tek başına kanıtlamaz; diseksiyon, vaskülit, vazospazm ve Moyamoya klinik ve damar duvarı bulgularıyla ayrılır.

Kendini dene

1. CTA'da intrakraniyal stenoz derecesini ölçmek için DSA ile en yüksek uyumu gösteren yarı otomatik protokol hangisidir?

   • (1 − stenozun en küçük çapı / referansın ortalama çapı) × 100
   • (1 − stenozun ortalama çapı / referansın en küçük çapı) × 100
   • Stenozun en küçük çapı ile referansın ortalama çapını toplamak
   • Stenozun en büyük çapını referansın ortalama çapına bölmek
   Cevabı göster

   (1 − stenozun en küçük çapı / referansın ortalama çapı) × 100. Kaynakta DSA ile en yüksek uyum gösteren CTA protokolü, stenozun en küçük çapının referansın ortalama çapına oranı kullanılarak (1 − oran) × 100 biçiminde tanımlanmıştır.

2. CTA'da kavernöz sinüs yakınındaki intrakraniyal ICA için bildirilen görüntüleme sınırlılığı hangisidir?

   • Artefakt nedeniyle damar yapay olarak daralmış veya görünmez görünebilir
   • Damar duvarı plak bileşimi her zaman kesin belirlenir
   • Distal akım yönü doğrudan ölçülür
   • Damar çapı artefaktlardan etkilenmez
   Cevabı göster

   Artefakt nedeniyle damar yapay olarak daralmış veya görünmez görünebilir. Kaynak, duyarlılık artefaktlarının kavernöz sinüs yakınında intrakraniyal ICA'yı yapay olarak daralmış veya görünmez gösterebileceğini bildirir.

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.