Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, 7th floor, Tampa, FL, 33606, USA.
Department of Radiology, University of South Florida, Tampa, FL, USA.
Curr Pain Headache Rep. 2017 Oct 13;21(12):47. doi: 10.1007/s11916-017-0649-1.
Cerebral cavernous malformations (CCMs) are common vascular abnormalities often discovered on imaging as an incidental finding. The most common clinical presentations of CCMs include seizure, headache, focal neurological deficits, and intracranial hemorrhage. This article discusses the most recent guidelines including imaging diagnostic criteria and radiographic standards of CCMs and reviews the utility of currently available imaging techniques.
Gradient echo T2*-weighted imaging and susceptibility-weighted imaging are the recommended imaging protocols for evaluation of suspected CCMs. Diffusion tensor imaging-based tractography provides visualization of the eloquent white matter tracks in the brain. This imaging is increasingly used in clinical practice to assist in selecting the optimal surgical approach, especially for brainstem lesions. Quantitative susceptibility mapping and dynamic contrast-enhanced quantitative perfusion are presently considered experimental. Its proposed value might prove helpful in the future to monitor disease activity and response to treatments. The choice of imaging modality of CCMs depends on the goals the clinician expects to achieve, such as establishing the initial diagnosis, follow-up and monitoring disease activity, preoperative, intraoperative, and postoperative evaluation, or research and experimental work on patients with CCM.
脑海绵状血管畸形（CCMs）是常见的血管异常，通常在影像学检查中作为偶然发现。CCMs 的最常见临床表现包括癫痫发作、头痛、局灶性神经功能缺损和颅内出血。本文讨论了最新的指南，包括 CCM 的影像学诊断标准和影像学标准，并回顾了目前可用的影像学技术的应用。
梯度回波 T2*-weighted 成像和磁敏感加权成像被推荐用于评估疑似 CCMs。基于弥散张量成像的轨迹提供了大脑中脑白质束的可视化。这种成像技术在临床实践中越来越多地用于辅助选择最佳手术入路，特别是对于脑干病变。定量磁敏感图和动态对比增强定量灌注目前被认为是实验性的。其预期的价值可能有助于未来监测疾病的活动和对治疗的反应。CCMs 的影像学检查方式的选择取决于临床医生预期达到的目标，例如确定初始诊断、随访和监测疾病活动、术前、术中和术后评估，或对 CCM 患者的研究和实验工作。
