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Diagnosticul
imagistic al patologiei
hipotalamo - hipofizare
Ion Preguza
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Tehnici de explorare radioimagistica in functie de bazele fizice sunt:
tehnici ce utilizeaza razele X: radiografii, mielografii, CT
tehnici imagistice ce utilizeaza alte modalitati de obiectivare a structurilor anatomice:
ecografia, IRM
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ANALIZA UNUI CT CEREBRALSistematic, se urmareste: depistarea anomaliilor de densitate (hipo/ hiper) intraparenchimatoase
hiperdensitate: sange, calcificari hipodensitate: edem, chist, cavitate porencefalica... mixte: procese expansive neomogena cu calcificari / necroza intratumorala, /sangerari /componente
chistice, edem perilezional anomalii de densitate si dimensiuni ale spatiilor extracerebrale colectii subdurale, epidurale : hematice, seroase, mixte + rasunetul asupra structurilor
nervoase efect de masa / tractiune compresia unui ventricul devierea structurilor liniei mediane (coasa creierului, ventricul III, apeduct Sylvius) cautarea senmnelor de angajare cerebrala = angajare subfalciforma, temporala,
diencefalica, a amigdalelor cerebeloase in gaura mare occipitala analiza spatiilor intergirale (reduse / dilatate)INDICATII:- in ansamblu, toata patologia neurologica si neurochirurgicala poate beneficia de
examinare CTLIMITE:sensibilitate redusa in depistarea unor leziuni functie de natura acestora(placa de
demielinizare, astrocitom de grad mic)dimensiuni mici ale leziuniilocalizarea in fosa posterioara
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Secventa scurta T1 Secventa lunga T2, DP
contrast anatomic (s.a. alba, s.c. gri, LCR negru) leziune = hiposemnal grasime, metHb, melanina = Hsemnal
contrast invers (LCR > s.c .> s.a.) leziune = hipersemnal lichide = hipersemnal
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Patologiile localizate in regiunea sella turcica ocupa un rol aparte in patologiile intracraniene din cauza structurilor de importanta vitala situate in regiune:
• Hipofiza.• Arterele carotide (si implicit inelul arterial al
creerului).• Sinusul cavernos (+ nervii cranieni).• Chiasma optica (0.5 cm supraselar).
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Microadenomul Hipofizar:
Adenom cu diametru <10mm situat in hipofiza.
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In T1 – hipo. In T2 – hiper. Diagnostic diferential: adenom sau chist
Rathke.
Microadenomul Hipofizar:
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Sensibilitatea MRI simplu in detectarea unui microadenom hipofizar este de aprox 70%.
Administrarea de gadoliniu reduce rezultatele fals negative de la 30% la 15%.
Microadenomul Hipofizar:
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Microadenomul Hipofizar:
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Adenom cu diametru >10mm. Deseori prezinta arii de necroza si
hemoragii. Initial extind sella turcica, apoi se extind
supraselar, compresind chiasma optica sau alte structuri, cu manifestari clinice corespunzatoare.
Macroadenomul Hipofizar:
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Din cauza prezentei diafragmei macroadenoamele au o configuratie tipica de om de zapada.
Diagnostic diferential de meningiom.
♠ Suplimentar numai macroadenoamele extind sella turcica.
Macroadenomul Hipofizar:
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Meningiom
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Interventie Chirurgicala:
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Extindere in sinusul cavernos: Diagnostic diferential: meningioamele tind
sa comprime artera (arterele) carotida, iar adenoamele nu (tesut practic lipsit de stroma).
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Prolactinom Tratament conservativ.
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Chist Rathke In T1 hiper( numai lichid, singe sau grasimi)
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CranioFaringiom: Tumora din epiteliul Rathke.
Benigna dar cu crestere local invaziva.
Poate prezenta focare de necroza, hemoragii, cavitati chistice.
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CranioFaringiom:
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CranioFaringiom: Sectiuni Sagitale
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Sectiuni coronale
CranioFaringiom:
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Sectiuni axiale.
CranioFaringiom:
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CT – calcificari.
CranioFaringiom:
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Meningiom: Cea mai frecventa tumora intracraniana. In
20% apare la baza craniului. De regula tumori solide cu cavitati chistice.
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CT & IRM
Meningiom:
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Meningiom:
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Compresia hipofizei.
Meningiom:
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Anevrism:
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Anevrism:
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Anevrism:
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Aplazie:
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Aplazie:
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Aplazie: