Vaskuläre Zufallsbefunde in der MRT des Schädels

In etwa 9 von 1000 kranialen MRT-Untersuchungen werden pathologische Veränderungen der zerebralen Gefäße entdeckt. Radiologen sind häufig diejenigen, die ihren Patienten solche Zufallsbefunde mitteilen. Die Betroffenen sind oft verunsichert und wollen wissen, was dieser Befund für sie bedeutet. Es ist daher das Ziel dieses Beitrags, Grundlagen für eine adäquate Beratung über die Risiken und das weitere Vorgehen zu vermitteln.

Schlüsselwörter

Zufallsbefund - Hirngefäße - Aneurysma - AVM - AV-Fistel - Kavernom

Publication History

Article published online:
03 March 2023

• Literatur

• 1 Flores-Montanez Y, Nhas S. Unusual brain MRI findings in patients imaged for headache: a case series. Curr Pain Headache Rep 2020; 24: 51 DOI: 10.1007/s11916-020-00881-9.
• 2 Kmtchum-Tatuene J, Kenteu B, Fogang YF. et al. Neuroimaging findings in headache with normal neurologic examination: Systematic review and meta-analysis. J Neurol Sci 2020; 416: 116997 DOI: 10.1016/j.jns.2020.116997.
• 3 Vernooij MW, Ikram MA, Tanghe HL. et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357: 1821-1828 DOI: 10.1056/NEJMoa070972. (PMID: 17978290)
• 4 Sunny DE, Amoo M, Al Breiki M. et al. Prevalence of incidental intracranial findings on magnetic resonance imaging: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; DOI: 10.1007/s00701-022-05225-7. (PMID: 35525892)
• 5 Etminan N, Dörfler A, Steinmetz H. Unrupturierte intrakranielle Aneurysmen – Pathogenese und individualisierte Behandlung. Dtsch Arztebl Int 2020; 117: 235-242
• 6 Hm Vlak M, Algra A, Brandenburg R. et al. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 2011; 10: 626-636
• 7 Greving JP, Wermer MJH, Brown RD. et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13: 59-66 DOI: 10.1016/S1474-4422(13)70263-1. (PMID: 24290159)
• 8 Etminan N, de Sousa DA, Tiseo C. et al. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7 DOI: 10.1177/23969873221099736. (PMID: 36082246)
• 9 Nam JS, Jeon SB, Jo JY. et al. Perioperative rupture risk of unruptured intracranial aneurysms in cardiovascular surgery. Brain 2019; 142: 1408-1415 DOI: 10.1093/brain/awz058. (PMID: 30851103)
• 10 Molenberg R, Aalbers MW, Metzemaekers JDM. et al. Clinical relevance of short-term follow-up of unruptured intracranial aneuysms. Neurosurg Focus 2019; 47: E7 DOI: 10.3171/2019.4.FOCUS1995.
• 11 Can A, Gross BA, Du R. The natural history of cerebral arteriovenous malformations. Handb Clin Neurol 2017; 143: 15-24 DOI: 10.1016/B978-0-444-63640-9.00002-3. (PMID: 28552137)
• 12 Stapf C, Mohr JP, Choi JH. et al. Invasive treatment of unruptured brain arteriovenous malformations is experimental therapy. Curr Opin Neurol 2006; 19: 63-68 DOI: 10.1097/01.wco.0000200546.14668.78. (PMID: 16415679)
• 13 Platz J, Berkefeld J, Singer O. et al. Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir (Wien) 2014; 156: 2025-2034
• 14 Mohr JP, Overbey JR, Hartmann A. et al. Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations (ARUBA): final follow-up of a multicenter, non-blinded, randomised controlled trial. Lancet Neurol 2020; 19: 573-581
• 15 Mohr JP, Paridis MK, Stapf C. et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, nonblinded, randomised trial. Lancet 2014; 383: 614-621 DOI: 10.1016/S0140-6736(13)62302-8. (PMID: 24268105)
• 16 Chen C-J, Ding D, Derdeyn CP. et al. Brain arteriovenous malformations: A review of natural history, pathobiology, and interventions. Neurology 2020; 95: 917-927 DOI: 10.1212/WNL.0000000000010968. (PMID: 33004601)
• 17 Watanabe K, Kakeda S, Watanabe R. et al. Normal flow signal of the pterygoid plexus on 3 T MRA in patients without DAVF of the cavernous sinus. AJNR Am J Neuroradiol 2013; 34: 1232-1236
• 18 Elhammady MS, Ambeker S, Heros RC. Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. Handb Clin Neurol 2017; 143: 99-105
• 19 Söderman M, Pavic L, Edner G. et al. Natural history of dural arteriovenous shunts. Stroke 2008; 39: 1735-1739 DOI: 10.1161/STROKEAHA.107.506485. (PMID: 18388337)
• 20 Kobayashi A, Al-Shahi Salman R. Prognosis and treatment of intracranial dural arteriovenous fistulae: A systematic review and meta-analysis. J Stroke 2014; 9: 670-677
• 21 Idiculla PS, Guralla D, Philipose J. et al. Cerebral cavernous malformations, developmental venous anomaly, and its coexistence: A review. Eur Neurol 2020; 83: 360-368
• 22 Pu Y, DouXLiu L. Natural history of intracranial atherosclerotic disease. Front Neurol 2014; 5: 125 DOI: 10.3389/fneur.2014.00125.
• 23 Chimowitz MI Lynn MJ, Derdeyn CP. et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365: 993-1003 DOI: 10.1056/NEJMoa1105335. (PMID: 21899409)