头颈部高流量血管病变与临床及血流动力学模拟病变的鉴别：基于模式的多模态影像方法
本文为来自新加坡两家三级机构的图像综述，提出基于模式的多模态影像方法鉴别头颈部真性高流量血管病变（AVM、AVF、CCF）与模拟病变（颈动脉壁病变如假性动脉瘤、颈动脉破裂、夹层及富血供肿瘤如副神经节瘤）。真性病变以直接动静脉分流为特征，关键影像表现包括早期静脉显影、动脉化静脉引流及AVM中的瘤巢；模拟病变缺乏真正动静脉交通。先进影像技术如3D CT血管重建和时间分辨对比增强MR血管成像（如TWIST）可改善血管结构勾勒和血流模式动态评估，DSA仍是明确特征和制定治疗计划的关键。
要点
- 识别直接动静脉分流是鉴别真性高流量血管病变与模拟病变的核心。
- 早期静脉显影、动脉化静脉引流及瘤巢是AVM等真性病变的关键征象。
- 模拟病变可表现为临床或表观高流量特征，但缺乏真正动静脉交通。
核心结论
- 鉴别真性高流量血管病变与模拟病变依赖于识别关键血流动力学和结构影像特征，尤其是动静脉分流的存在。
- 基于模式的多模态影像方法有助于准确诊断、指导适当管理并减少具有临床意义的模拟病变的误分类。
研究设计与样本
- 本文为精选图像综述，病例来自新加坡两家三级机构。
- 纳入真性高流量血管病变（AVM、AVF、CCF）及模拟病变（颈动脉壁病变如假性动脉瘤、颈动脉破裂、夹层；富血供肿瘤如副神经节瘤）。
- 分析超声、CT、MRI和DSA的影像表现，重点为结构和血流动力学特征。
关键影像表现/征象
- 真性高流量血管病变以直接动静脉分流为定义特征，关键影像表现包括早期静脉显影、动脉化静脉引流及AVM中的瘤巢。
- 模拟病变可显示重叠的临床表现或表观高流量特征，但缺乏真正动静脉交通。
- 3D CT血管重建和时间分辨对比增强MR血管成像（如TWIST）可改善血管结构勾勒并实现血流模式动态评估。
诊断标准与关键数值
- 真性高流量血管病变的定义标准为直接动静脉分流，关键影像特征包括早期静脉显影、动脉化静脉引流和瘤巢（AVM）。
临床应用与阅片要点
- 阅片时应重点寻找直接动静脉分流征象（早期静脉显影、动脉化静脉引流、瘤巢）以鉴别真性高流量血管病变与模拟病变。
- 对于临床或影像上表现为高流量特征的病例，需注意排除缺乏真正动静脉交通的模拟病变，避免误分类。
- DSA仍是明确特征和制定治疗计划的关键手段。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To present a pattern-based, multimodality imaging approach for differentiating true high-flow vascular lesions from their clinical, imaging, and hemodynamic mimics in the head and neck.
METHODS: This curated pictorial review draws on cases from two tertiary institutions in Singapore, encompassing true high-flow vascular lesions - including arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), and carotid-cavernous fistulas (CCFs) - as well as mimics, including carotid arterial wall pathologies (e.g. pseudoaneurysms, carotid blowout, dissections) and hypervascular tumors (e.g. paragangliomas). Imaging findings across ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) were analyzed, with emphasis on structural and hemodynamic features.
RESULTS: True high-flow vascular lesions are defined by direct arteriovenous shunting, with key imaging features including early venous opacification, arterialized venous drainage, and the presence of a nidus (in AVMs). In contrast, mimics may demonstrate overlapping clinical presentations or apparent high-flow characteristics but lack true arteriovenous communication. Advanced imaging techniques - including 3D CT angiographic reconstructions and time-resolved contrast-enhanced MR angiography (e.g. TWIST) - improve delineation of vascular architecture and enable dynamic assessment of flow patterns. Digital subtraction angiography remains essential for definitive characterization and treatment planning.
CONCLUSION: Differentiation of true high-flow vascular lesions from their mimics relies on recognition of key hemodynamic and structural imaging features, particularly the presence of arteriovenous shunting. A pattern-based multimodality imaging approach facilitates accurate diagnosis, guides appropriate management, and reduces misclassification of clinically significant mimics.
引用
- Tan XY, McAdory LE, Guo S, et al. Differentiating high-flow vascular lesions from clinical and hemodynamic mimics in the head and neck: a pattern-based multimodality imaging approach. Neuroradiology. 2026. PMID: 42118242. doi:10.1007/s00234-026-04012-w
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。