Bildgebung der Hirnvenen bei Kindern: jenseits der duralen Sinusvenenthrombose

Die Sinusthrombose ist eine häufige Erkrankung, die in der Literatur bereits ausgiebig diskutiert wurde. Jedoch gibt es weitere zerebrale Venenerkrankungen bei Kindern, zu denen deutlich weniger publiziert wurde. Dieser Beitrag liefert eine Übersicht über die relevante Embryologie und Anatomie sowie geeignete bildgebende Verfahren. Anschließend werden angeborene, entwicklungsbedingte und erworbene kindliche zerebrale Venenpathologien besprochen.

Kernaussagen

• Im Vergleich zur arteriellen Entwicklung ist die intrakranielle Venenentwicklung ein relativ passiver Prozess, der von hämodynamischen und Zirkulationsfaktoren beeinflusst wird. Diese werden u.a. in Abhängigkeit von der lokalen Sauerstoffkonzentration aktiviert. Die Venenanatomie ist daher von Individuum zu Individuum sehr unterschiedlich.

• Die oberflächlichen kortikalen Venen, die die äußere Grenzmembran der Arachnoidea und die durale Grenzzellschicht auf ihrem Weg zu den duralen Sinus durchdringen, werden als Brückenvenen bezeichnet. Die Verletzung der relativ festen Brückenvenensegmente bei einem unfallbedingten oder misshandlungsbedingten Kopftrauma führt häufig zur Bildung eines Subduralhämatoms.

• Die MRT ist die am häufigsten eingesetzte Methode zur Darstellung kindlicher intrakranieller Venenanomalien. Zu den oft verwendeten MRT-Sequenzen gehören T1w, T2w, T2w FLAIR- und T2*w oder suszeptibilitätsgewichtete Sequenzen sowie in ausgewählten Fällen kontrastverstärkte T1w 3-D-Gradienten-Echo-Sequenzen.

• Die Auswahl der Technik für die MR-Venografie kann auf der Grundlage der verfügbaren Sequenzen, der Dauer der gewünschten Untersuchung, des Verdachts auf eine Anomalie und der klinischen Bedeutung der Bildgebung bestimmter Gruppen von oberflächlichen Hirnvenenstrukturen (z.B. Sinus sagittalis superior bei Verdacht auf Thrombose oder parasagittale Brückenvenen bei durch Misshandlung verursachtem Kopftrauma) angepasst werden.

• Zu den neueren Techniken, die eine Verbesserung der Hirnvenenbildgebung bei Kindern versprechen, gehören die Dual-Energy-CT, die 4-D-Fluss-MRT und Anwendungen der künstlichen Intelligenz wie die synthetische MRT.

Schlüsselwörter

Hirnvenenanomalien - Hirnvenenerkrankung - Kopftrauma - Kinder - Bildgebung

Publikationsverlauf

Artikel online veröffentlicht:
01. Oktober 2024

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