Normal ventriküler sistem ve BOS boşlukları BT bulguları

Özet

Kafa BT'sini değerlendiren herkesin ventriküller ile ekstraaksiyel BOS boşluklarının beklenen devamlılığını ve simetrisini tanıması gerekir. Beyin BT'sinde ventrikül genişlemesi ve transependimal ödem görülebilir. Normal anatominin bilinmesi yaşa bağlı hacim kaybını, asimetriyi ve bası bulgularını patoloji sanmayı azaltır. Sıkışmış bazal sisternler veya beklenmedik ventrikül genişlemesi gözden kaçarsa herniasyon ya da BOS akım tıkanıklığı gecikebilir.

Faz ve pencere

Kontrastsız tanısal: BOS, beyin parankimine göre düşük atenüasyonlu görünür; lateral ve üçüncü ventriküller orta hat çevresinde, dördüncü ventrikül posterior fossada izlenir. Beyin BT'si beyin yapılarının değerlendirilmesinde kullanılan bir görüntüleme yöntemidir.

Önerilen pencereler: Beyin (G 80 / M 40), Subdural (G 200 / M 75).

BT bulguları

Lateral ventriküllerin frontal boynuzları orta hatta göre dengeli ve konturları düzgün izlenir.
Üçüncü ventrikül, talamusların arasında ince BOS aralığı olarak orta hatta yer alır.
Serebral akuadukt boyunca dördüncü ventriküle uzanan BOS yolu kesintisiz anatomik dizilim gösterir.
BT'de bazal sisternlerin açıklığı ve beyin sapı basısı değerlendirilebilir.
Sylvian fissürler ve yüksek konveksite sulkusları görüntülenebilir; genişlik yaş ve beyin hacmi ile ilişkili değişkenlik gösterebilir.
Falx ve septum pellusidum orta hatta bulunur; ventrikül konturlarında belirgin yer değiştirme yoktur.

Normalde

Aksiyel kesitte lateral ventriküllerin frontal boynuzları orta hatta simetrik görünür; üçüncü ventrikül orta hatta yer alır. Mezensefalon düzeyinde suprasellar ve interpedinküler sisternler açıktır, Sylvian fissürler ile kortikal sulkuslar seçilir; kıyasta asimetri, silinme ve ventrikül-sulkus uyumsuzluğunu ara.

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

Hidrosefali: ventriküller genişleyebilir.
Serebral atrofi: ventriküllerle birlikte kortikal sulkus ve Sylvian fissürler de genişler.
Yaygın serebral ödemde bazal sistern basısı ve orta hat kayması eşlik edebilir.
Kitle etkisi: ventrikül asimetrisiyle birlikte septum pellusidum veya üçüncü ventrikül yer değiştirebilir.

Tuzaklar

Lateral ventrikül asimetrisi, infantlarda normal anatomik varyant olarak görülebilir.
Yaşlı hastada geniş ventrikülleri otomatik hidrosefali sayma; yüksek konveksite sulkuslarının ve Sylvian fissürlerin eşlik eden genişliğine bak.
Küçük bazal sisternler tek kesitte parsiyel hacim etkisiyle dar görünebilir; komşu aksiyel kesitlerde sisternal konturu izle.

Kendini dene

Yaşlı bir hastada lateral ventrikül genişlemesine, subaraknoid ve bazal sisternal BOS hacminin beyin hacmine oranında artış eşlik ediyor. Bu görünüm en çok hangi durumla uyumludur?
Cevabı göster
Serebral atrofi. Serebral atrofide subaraknoid alan ve bazal sisternlerin beyin hacmine oranı, normal basınçlı hidrosefali grubuna göre daha yüksek bulunmuştur. Obstrüktif hidrosefalide ventriküller sulkuslara göre orantısız genişleyebilir; ödem boşlukları daraltır; kitle etkisi orta hat yapılarında yer değiştirme oluşturur.
BOS dolaşımı veya emilimindeki bozulma hidrosefaliyle birlikte hangi değişikliğe yol açabilir?
Cevabı göster
Ventriküllerin genişlemesi. BOS dolaşımı veya emilimindeki bozulma hidrosefaliye ve ventrikül genişlemesine yol açabilir.

İlgili konular

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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