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Brain and Nerve No to Shinkei Volume 42, Issue 6 （June 1990）

Brain and Nerve 脳と神経 42巻6号（1990年6月発行）

Japanese English

原著

脳動脈瘤破裂によるくも膜下出血のMRI MAGNETIC RESONANCE IMAGING OF SUBARACHNOID HEMORRHAGE DUE TO RUPTURED INTRACRANIAL ANEURYSM 山上達人 ¹ , 東健一郎 ¹ , 田代弦 ² , 橋本研二 ² , 南川順 ² , 秋山義典 ² , 橋本信夫 ² , 菊池晴彦 ² Tatsuhito Yamagami ¹ , Ken-ichiro Higashi ¹ , Yuzuru Tashiro ² , Kenji Hashimoto ² , Jun Minamikawa ² , Yoshinori Akiyama ² , Nobuo Hashimoto ² , Haruhiko Kikuchi ² ¹医仁会武田総合病院脳神経外科 ²京都大学医学部脳神経外科 ¹Department of Neurosurgery, Ijinkai Takeda General Hospital ²Department of Neurosurgery, Kyoto University Medical School キーワード： SAH , MRI , intracranial aneurysm , ruptured aneurysm Keyword: SAH , MRI , intracranial aneurysm , ruptured aneurysm pp.583-590

発行日 1990年6月1日 Published Date 1990/6/1

DOI https://doi.org/10.11477/mf.1406900068

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Abstract 文献概要
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　破裂脳動脈瘤によるくも膜下出血（SAH）31例のMRI所見について検討した。T1強調画像（T1W），T2強調画像（T2W），SR 1000／60（SR像）のpulse sequenceを使用した。1）破裂脳動脈瘤の急性期では，動脈瘤近傍のくも膜下腔がT1Wにて，isointensity, SR像にて，high intensityとして認められた。亜急性期には，T1W, SR像共に，high intensityとなった。T2Wでもhjgh in—tensityであった。2）SR像にて，脳室内の出血が，特に側脳室後角にniveau状のhigh intensityとして良く描出された。3）脳動脈瘤自体を直接描出するには，SR像かT2Wが適していた。常電導MRIでは解像力に問題があり，小さな動脈瘤の描出は困難であったが，それでも，29％に可能であった。4）T1WやT2Wも，脳内血腫や脳虚血領域の同定に有用であった。5）MRIでは，この様に，SAHによる異常所見，付随する所見，またSAHとは直接関係のない所見も含めて三次元的に把握する事ができた。6）MRIは，X線CTにない利点を有しているので，脳動脈瘤破裂によるSAHの例におけるMRIの使用は，X線CTに対し付加的な価値を与えるものである。

We report MRI (magnetic resonance imaging) findings of 31 cases with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm. Among these cases, 25 were studied within 72 hours after onset of SAH.

A resistive type MRI scanner operating at a field of 0. 2 Tesla was used in obtaining inversion recovery (IR) and saturation recovery (SR) images. IR 1500/43/400 (T₁ weighted image,T₁W), SR 1000/ 60 (SR image) and SR 2000/100 (T₂ weighted image, T₂W) were chosen for analysis. The SR image was usually adopted and coronal and/or sagittal images were added when there was enough time for examination. Slice thickness was 10 mm and slice interval was 15 mm. The scan was not necessarily aimed at the visualization of aneurysm itself.

1) In the acute phase of SAH, subarachnoidspaces near the ruptured aneurysm were appeared as isointensity areas on T₁W and as high intensity areas on SR image. In the subacute phase, they were depicted as high intensity areas on both T₁W and SR images, and as high intensity areas on T₂W. 2) Intraventricular hemorrhage was visua-lized as a niveau-like high intensity area, especial-ly, within the posterior horns on the SR images. 3) SR and T₂W images were suitable for detection of aneurysm itself. In a resistive-type scanner, small aneurysms were not easily visualized due to the lack of high resolution. However, 29% of aneuysms, which were not giant, could be visua-lized on MRI. 4) Identification of intracerebral hemorrhage and cerebral ischemia from various causes was easy on both T₁W and T₂W images. 5) By MRI, these abnormal findings due to SAH and other unrelated findings were understood as three-dimensional image. 6) MRI examination was useful in the cases with SAH due to ruptured intracranial aneurysms from the point of view that MRI is complementary to x-ray CT.