BRAIN MR - PATHOLOGIC CORRELATION WITH GROSS AND HISTOPATHOLOGY .1. LACUNAR INFARCTION AND VIRCHOW-ROBIN SPACES
BRAIN MR - PATHOLOGIC CORRELATION WITH GROSS AND HISTOPATHOLOGY .1. LACUNAR INFARCTION AND VIRCHOW-ROBIN SPACES
复制标题
DOI：
10.2214/ajr.151.3.551
复制
发表时间：
1988-09-01
影响因子：
5
通讯作者：
SCHLAEPFER, WW
中科院分区：
文献类型：
--
作者：
BRAFFMAN, BH;ZIMMERMAN, RA;SCHLAEPFER, WW
对36例经福尔马林固定的脑标本进行磁共振成像。对于其中的三个标本，还在死亡前进行了体内核磁共振研究。讨论了固定后脑MR外观的变化。肉眼及镜下病理显示7例腔隙性侵犯14例，4例腔隙增大。两种类型的病变主要见于老年高血压患者。8个陷窝位于深部灰质核（4个位于壳核，不同程度受累于内囊核和尾状核，2个位于丘脑，2个位于齿状核），5个位于幕上白质区，1个位于脑干。基底节区Virchow-Robin间隙增大。所有病变在mr - CT上均未发现脑干、齿状陷窝和增大的Virchow-Robin间隙。磁共振成像显示，除一个圆形腔隙外，所有腔隙均呈裂隙状或卵形。除两例外，其余病例的最大直径均小于1厘米。在所有病例中，腔隙在长TR序列（短te和长te）上相对于脑实质都是高强度的，除了慢性梗死患者发生囊性改变，在所有脉冲序列上相对于脑脊液是等强度的。相反，在所有四个病例中，在所有脉冲序列中，扩张的Virchow-Robin腔相对于体内脑脊液或死后状态下蛛网膜下腔中的液体是等强度的。它们是圆形或线状的，通常比腔隙小，尽管在大小上确实有一些重叠。它们出现在颈内动脉分叉到大脑中动脉和前动脉的正上方，也出现在壳核（沿其外侧缘最突出）和内囊的连续轴向切片上。腔隙和扩张的Virchow-Robin间隙的大体和显微病理mri研究有助于将MR和病理结果联系起来。然而，当死后和体内MR结果相关联时，必须考虑固定过程引起的变化。
MR imaging was performed on 36 formalin-fixed brain specimens. For three of these specimens, in vivo MR studies has also been performed before death. Changes that take place in the MR appearance of the brain after fixation are discussed. Gross and microscopic pathology revealed 14 lacunar infractions in seven cases and enlarged Virchow-Robin spaces (etat crible) in four. Both types of lesion were seen in specimens from predominantly elderly, hypertensive patient. Eight lacunae were in the deep gray-matter nuclei (four in the putamen with variable involvement of the internal capsule and caudate nuclei, two in the thalami, and two in the dentate nuclei), five were in the supratentorial white manner, and one was in the brainstem. Enlarged Virchow-Robin spaces were identified in the basal ganglia. All lesions were detected on MR. CT failed to disclose the brainstem and dentate lacunae and the enlarged Virchow-Robin spaces. On MR, all lacunae were slitlike or ovoid, except one that was round. They were less than 1 cm in greatest diameter in all but two cases. The lacunae were hyperintense relative to brain parenchyma on both long TR sequences (short and long TEs) in all cases except that of a chronic infarct that underwent cystic change and was isointense relative to CSF on all pulse sequences. In contrast, dilated Virchow-Robin spaces were isointense relative to CSF in vivo or to fluid in the subarachnoid space in the postmortem state on all pulse sequences in all four cases. They were round or linear, and in general were smaller than the lacunae, although some overlap in size did occur. They were seen at the level immediatiely above the bifurcation of the internal carotid into the middle and anterior cerebral arteries and were seen on successive axial sections in the putamen (most prominent along its lateral margin) and in the internal capsule. MR studies of gross and microscopic pathology of lacunae and dilated Virchow-Robin spaces are useful in correlating MR and pathologic findings. However, changes resulting from the fixation process must be considered when postmortem and in vivo MR findings are correlated.