MRI vessel wall imagingにて偽陽性を呈した後大脳動脈紡錘状動脈瘤の1例

MRI vessel wall imaging（VWI）で偽陽性を呈した後大脳動脈紡錘状動脈瘤の症例を報告する．症例は55歳男性で，継続する頭痛を主訴に救急受診した．CT，MRIで中脳周囲と後頭葉に少量のくも膜下出血を認めた．造影CTでは前交通動脈瘤と後大脳動脈瘤を認めた．VWIでは後大脳動脈瘤に造影効果を認めたため，血腫分布と併せて出血源と判断した．病変部のトラッピングと，遠位部に浅側頭動脈–後大脳動脈バイパスを作成する方針で手術を行ったが，術中所見としては未破裂の広基性動脈瘤であった．動脈形成的にクリッピングを施行した．VWIの偽陽性が起こりやすい状況を理解し，マルチモダリティにおける判断...

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Published in脳卒中 Vol. 47; no. 1; pp. 31 - 36
Main Authors 武, 裕士郎, 大井川, 秀聡, 横山, 大騎, 望月, 賢紀, 吉田, 馨次朗, 鈴木, 海馬, 栗田, 浩樹
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中学会 2025
日本脳卒中学会
Subjects
perimesencephalic subarachnoid hemorrhage
posterior cerebral artery aneurysm
vessel wall imaging
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Abstract MRI vessel wall imaging（VWI）で偽陽性を呈した後大脳動脈紡錘状動脈瘤の症例を報告する．症例は55歳男性で，継続する頭痛を主訴に救急受診した．CT，MRIで中脳周囲と後頭葉に少量のくも膜下出血を認めた．造影CTでは前交通動脈瘤と後大脳動脈瘤を認めた．VWIでは後大脳動脈瘤に造影効果を認めたため，血腫分布と併せて出血源と判断した．病変部のトラッピングと，遠位部に浅側頭動脈–後大脳動脈バイパスを作成する方針で手術を行ったが，術中所見としては未破裂の広基性動脈瘤であった．動脈形成的にクリッピングを施行した．VWIの偽陽性が起こりやすい状況を理解し，マルチモダリティにおける判断を行うことが正確な診断に重要である．
AbstractList 要旨:MRI vessel wall imaging(VWI)で偽陽性を呈した後大脳動脈紡錘状動脈瘤の症例を報告する. 症例は55歳男性で, 継続する頭痛を主訴に救急受診した. CT, MRIで中脳周囲と後頭葉に少量のくも膜下出血を認めた. 造影CTでは前交通動脈瘤と後大脳動脈瘤を認めた. VWIでは後大脳動脈瘤に造影効果を認めたため, 血腫分布と併せて出血源と判断した. 病変部のトラッピングと, 遠位部に浅側頭動脈-後大脳動脈バイパスを作成する方針で手術を行ったが, 術中所見としては未破裂の広基性動脈瘤であった. 動脈形成的にクリッピングを施行した. VWIの偽陽性が起こりやすい状況を理解し, マルチモダリティにおける判断を行うことが正確な診断に重要である.
MRI vessel wall imaging（VWI）で偽陽性を呈した後大脳動脈紡錘状動脈瘤の症例を報告する．症例は55歳男性で，継続する頭痛を主訴に救急受診した．CT，MRIで中脳周囲と後頭葉に少量のくも膜下出血を認めた．造影CTでは前交通動脈瘤と後大脳動脈瘤を認めた．VWIでは後大脳動脈瘤に造影効果を認めたため，血腫分布と併せて出血源と判断した．病変部のトラッピングと，遠位部に浅側頭動脈–後大脳動脈バイパスを作成する方針で手術を行ったが，術中所見としては未破裂の広基性動脈瘤であった．動脈形成的にクリッピングを施行した．VWIの偽陽性が起こりやすい状況を理解し，マルチモダリティにおける判断を行うことが正確な診断に重要である．
Author 大井川, 秀聡
横山, 大騎
吉田, 馨次朗
望月, 賢紀
栗田, 浩樹
鈴木, 海馬
武, 裕士郎
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References 14） Flaherty ML, Haverbusch M, Kissela B, et al.: Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis 2005; 14: 267–271
18） Hashimoto Y, Matsushige T, Kawano R, et al.: Focal aneurysm wall enhancement in vessel wall imaging as a surrogate marker for predicting aneurysm instability. Stroke Vasc Interv Neurol 2023; 3: e001029
17） Hafez A, Numminen J, Rahul R, et al.: Perimesencephalic subarachnoid hemorrhage with a positive angiographic finding: case report and review of the literature. Acta Neurochir 2016; 158: 1045–1049
8） Nagahata S, Nagahata M, Obara M, et al.: Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm? Clin Neuroradiol 2016; 26: 277–283
7） Larsen N, von der Brelie C, Trick D, et al.: Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-resolution MR imaging and correlated histologic findings. AJNR Am J Neuroradiol 2018; 39: 1617–1621
2） Nehls DG, Flom RA, Carter LP, et al.: Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985; 63: 342–348
3） Matouk CC, Mandell DM, Günel M, et al.: Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery 2013; 72: 492–496; discussion, 496
1） Zolnourian A, Borg N, Akhigbe T, et al.: Vessel wall imaging after subarachnoid hemorrhage in patients with multiple intracranial aneurysms: a cautionary case. World Neurosurg 2019; 127: 414–417
11） 松信八十男：血液の流体力学．日本流体力学会誌「ながれ」 1993; 12: 6–10
4） 山木哲，近藤礼，佐藤慎治ら：多発脳動脈瘤症例の破裂瘤特定における造影MRI vessel wall imagingの有用性．脳卒中の外 2018; 46: 25–30
6） Zhong W, Su W, Li T, et al.: Aneurysm wall enhancement in unruptured intracranial aneurysms: a histopathological evaluation. J Am Heart Assoc 2021; 10: e018633
9） Kang N, Qiao Y, Wasserman BA: Essentials for interpreting intracranial vessel wall MRI results: state of the art. Radiology 2021; 300: 492–505
15） Schievink WI, Wijdicks EF: Pretruncal subarachnoid hemorrhage: an anatomically correct description of the perimesencephalic subarachnoid hemorrhage. Stroke 1997; 28: 2572
13） Rinkel GJE, Wijdicks EFM, Vermeulen M, et al.: Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol 1991; 12: 829–834
16） Schwartz TH, Mayer SA: Quadrigeminal variant of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Neurosurgery 2000; 46: 584–588
5） Matsushige T, Shimonaga K, Mizoue T, et al.: Focal aneurysm wall enhancement on magnetic resonance imaging indicates intraluminal thrombus and the rupture point. World Neurosurg 2019; 127: e578–e584
10） 前田信治：教育講座：血液のレオロジーと生理機能　第1回：血行力学の基礎と血液粘度．日生理誌 2004; 66: 234–244
12） 板谷慶一：血流解析のすすめ 第3版．東京，Cardio flow design, 2023, pp 15–21
References_xml – reference: 5） Matsushige T, Shimonaga K, Mizoue T, et al.: Focal aneurysm wall enhancement on magnetic resonance imaging indicates intraluminal thrombus and the rupture point. World Neurosurg 2019; 127: e578–e584
– reference: 7） Larsen N, von der Brelie C, Trick D, et al.: Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-resolution MR imaging and correlated histologic findings. AJNR Am J Neuroradiol 2018; 39: 1617–1621
– reference: 18） Hashimoto Y, Matsushige T, Kawano R, et al.: Focal aneurysm wall enhancement in vessel wall imaging as a surrogate marker for predicting aneurysm instability. Stroke Vasc Interv Neurol 2023; 3: e001029
– reference: 6） Zhong W, Su W, Li T, et al.: Aneurysm wall enhancement in unruptured intracranial aneurysms: a histopathological evaluation. J Am Heart Assoc 2021; 10: e018633
– reference: 9） Kang N, Qiao Y, Wasserman BA: Essentials for interpreting intracranial vessel wall MRI results: state of the art. Radiology 2021; 300: 492–505
– reference: 13） Rinkel GJE, Wijdicks EFM, Vermeulen M, et al.: Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol 1991; 12: 829–834
– reference: 2） Nehls DG, Flom RA, Carter LP, et al.: Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985; 63: 342–348
– reference: 8） Nagahata S, Nagahata M, Obara M, et al.: Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm? Clin Neuroradiol 2016; 26: 277–283
– reference: 12） 板谷慶一：血流解析のすすめ 第3版．東京，Cardio flow design, 2023, pp 15–21
– reference: 17） Hafez A, Numminen J, Rahul R, et al.: Perimesencephalic subarachnoid hemorrhage with a positive angiographic finding: case report and review of the literature. Acta Neurochir 2016; 158: 1045–1049
– reference: 4） 山木哲，近藤礼，佐藤慎治ら：多発脳動脈瘤症例の破裂瘤特定における造影MRI vessel wall imagingの有用性．脳卒中の外 2018; 46: 25–30
– reference: 16） Schwartz TH, Mayer SA: Quadrigeminal variant of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Neurosurgery 2000; 46: 584–588
– reference: 10） 前田信治：教育講座：血液のレオロジーと生理機能　第1回：血行力学の基礎と血液粘度．日生理誌 2004; 66: 234–244
– reference: 14） Flaherty ML, Haverbusch M, Kissela B, et al.: Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis 2005; 14: 267–271
– reference: 11） 松信八十男：血液の流体力学．日本流体力学会誌「ながれ」 1993; 12: 6–10
– reference: 1） Zolnourian A, Borg N, Akhigbe T, et al.: Vessel wall imaging after subarachnoid hemorrhage in patients with multiple intracranial aneurysms: a cautionary case. World Neurosurg 2019; 127: 414–417
– reference: 3） Matouk CC, Mandell DM, Günel M, et al.: Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery 2013; 72: 492–496; discussion, 496
– reference: 15） Schievink WI, Wijdicks EF: Pretruncal subarachnoid hemorrhage: an anatomically correct description of the perimesencephalic subarachnoid hemorrhage. Stroke 1997; 28: 2572
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Snippet MRI vessel wall...
要旨:MRI vessel wall imaging(VWI)で偽陽性を呈した後大脳動脈紡錘状動脈瘤の症例を報告する. 症例は55歳男性で, 継続する頭痛を主訴に救急受診した. CT, MRIで中脳周囲と後頭葉に少量のくも膜下出血を認めた. 造影CTでは前交通動脈瘤と後大脳動脈瘤を認めた....
SourceID medicalonline
jstage
SourceType Publisher
StartPage 31
SubjectTerms perimesencephalic subarachnoid hemorrhage
posterior cerebral artery aneurysm
vessel wall imaging
Title MRI vessel wall imagingにて偽陽性を呈した後大脳動脈紡錘状動脈瘤の1例
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