Ozturk A, Saatci I, Pamuk A G, Erdogan C, Akmangit I, Geyik S, Cekirge H S
Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey.
AJNR Am J Neuroradiol. 2006 Oct;27(9):1866-75.
Cortical hyperdensity was observed in the immediate postembolization CT scans of some patients with intracranial aneurysms following uneventful endovascular treatments. The clinical significance and possible underlying mechanism were evaluated.
Ninety-three consecutive patients with a total of 100 intracranial aneurysms, treated by endosaccular packing, were studied. Seventy-four aneurysms were treated with balloon assistance, and the remaining aneurysms were treated without balloon assistance. All patients underwent cranial CT just before and immediately after the endovascular treatment. If the post-treatment CT showed any new finding, an immediate MR imaging and a repeat CT 4-6 hours after the initial posttreatment CT were performed. Several parameters were investigated related to the presence of cortical hyperdensity.
Cranial CT showed focal cortical hyperdensity following the treatment of 40/74 aneurysms (54%) with balloon remodeling and 9/26 aneurysms (34.6%) without balloon assistance. None of these patients were symptomatic, and cortical hyperdensity resolved in the repeat CT scans. A statistically significant relationship was observed between the presence of this finding and the total amount of contrast material, microcatheter time, number of balloon inflations, and total balloon inflation time.
Immediate postembolization CT may show focal cortical hyperdensity following uneventful endovascular aneurysm treatment, most likely caused by blood-brain barrier disruption resulting in accumulation of contrast medium. The hyperdensity was more frequent when balloon assistance was used but was also seen in the patients with no balloon use. It is important to differentiate this clinically insignificant finding from possible hemorrhage, which would affect patients' immediate postprocedural medical management.
在一些颅内动脉瘤患者接受顺利的血管内治疗后的栓塞后即刻CT扫描中观察到皮质高密度影。对其临床意义及可能的潜在机制进行了评估。
研究了93例连续的患者，共100个颅内动脉瘤，采用囊内填塞治疗。74个动脉瘤采用球囊辅助治疗，其余动脉瘤未采用球囊辅助治疗。所有患者在血管内治疗前及治疗后即刻均接受头颅CT检查。如果治疗后CT显示有任何新发现，则在初始治疗后CT检查后立即进行磁共振成像检查，并在4 - 6小时后重复CT检查。研究了与皮质高密度影存在相关的几个参数。
头颅CT显示，在采用球囊重塑治疗的74个动脉瘤中有40个（54%），未采用球囊辅助治疗的26个动脉瘤中有9个（34.6%）在治疗后出现局灶性皮质高密度影。这些患者均无症状，且在重复CT扫描中皮质高密度影消失。观察到这一发现的存在与造影剂总量、微导管操作时间、球囊充盈次数及总球囊充盈时间之间存在统计学显著相关性。
在顺利的血管内动脉瘤治疗后，栓塞后即刻CT可能显示局灶性皮质高密度影，最可能是由血脑屏障破坏导致造影剂积聚所致。使用球囊辅助时高密度影更常见，但未使用球囊的患者中也可见到。将这一临床无意义的发现与可能的出血区分开来很重要，因为这会影响患者术后的即时医疗管理。
