Endo Hidenori, Fujimura Miki, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital.
No Shinkei Geka. 2021 Mar;49(2):220-228. doi: 10.11477/mf.1436204382.
Intracranial aneurysms or arterial dissections are major causes of subarachnoid hemorrhage(SAH). Early surgical or endovascular repair of the bleeding source is crucial because rebleeding mostly occurs within a few days after the initial attack. Radiological examination is an initial step for the appropriate diagnosis of ruptured intracranial aneurysms and arterial dissections. However, misdiagnosis may occur, especially in patients with minor bleeding or multiple aneurysms. In addition to computed tomography, magnetic resonance imaging, including FLAIR and SWI, and T2WI are useful for detecting minor SAH. Vessel-wall imaging has recently been applied to diagnosing the site of rupture in patients with multiple cerebral aneurysms or microaneurysms, but not to assessing the instability of unruptured cerebral aneurysms or intracranial arterial dissections. In this article, we discuss the current radiological modalities and their usefulness for diagnosing SAH.
颅内动脉瘤或动脉夹层是蛛网膜下腔出血（SAH）的主要原因。对出血源进行早期手术或血管内修复至关重要，因为再出血大多发生在初次发作后的几天内。放射学检查是正确诊断破裂颅内动脉瘤和动脉夹层的第一步。然而，可能会出现误诊，尤其是在出血较少或患有多个动脉瘤的患者中。除计算机断层扫描外，包括液体衰减反转恢复序列（FLAIR）和磁敏感加权成像（SWI）以及T2加权成像（T2WI）在内的磁共振成像对于检测少量SAH很有用。血管壁成像最近已应用于诊断患有多个脑动脉瘤或微动脉瘤患者的破裂部位，但尚未用于评估未破裂脑动脉瘤或颅内动脉夹层的不稳定性。在本文中，我们讨论了当前的放射学检查方法及其在诊断SAH方面的作用。
