Böbrek yetmezlikli hastalarda FLAIR imajlarda subaraknoid aralık hiperintensitesi: Tanısal bir tuzak

Subaraknoid aralık (SAA) hiperintensitesi, manyetik rezonans görüntülemenin (MRG) FLAIR sekansında ayırıcı tanısı dikkatlice yapılması gereken önemli bir bulgudur. FLAIR sekansında SAA hiperintensitesinin subaraknoid kanama (SAK), leptomeningeal karsinomatozis, menenjit gibi ciddi tedavi gerektiren birçok nedeni vardır. Kontrast madde, vasküler pulsasyonlar, beyin omurilik sıvısı (BOS) pulsasyonları ve hareket artefaktları sadece tuzak görüntülerdir, bu nedenle de tedavi gerektirmezler. Böbrek yetmezlikli hastalar için birçok komorbidite sebebi bulunmaktadır. Bunlardan bir tanesi serebrovasküler olaylardır. Nörolojik semptomlara sahip hastalarda MRG tanı için en iyi tercihtir. Fakat hastaya beyin MR tetkiki öncesinde kontrastlı başka bir MRG incelemesi uygulan- mışsa gadolinyumun SAA'da gecikmiş klirensi ve persistansı ortaya çıkar. Sonuçta bu durum ciddi patolojileri taklit edebilir. Bu olgu sunumunda daha önce kontrastlı boyun MRG uygulanan böbrek yetmezlikli olgunun SAA hiperintensitesine ait ilginç görüntülerini sunmayı amaçladık.

Hyperintensity in the subarachnoid space on FLAIR MRI in patients with renal insufficiency: A diagnostic pitfall

Subarachnoid space (SAS) hyperintensity in fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) is an important finding that differantial diagnosis must be done carefully. FLAIR hyperintensity has lots of reasons: subarachnoid hemor- rhage (SAH), leptomemingeal carcinomatosis, meningitis, etc. which are required serious treatment. Some of the reasons such as contrast media, vascular-cerebrospinal fluid (CSF) pulsation, motion artifact are only pitfall, so no treatment is necessary for them. Patients with renal failure have comorbidities. One of them is cerebrovascular events and if patient has neurologic symptoms, MRI is the best choice for diagnosis. But if patient was applied gadolinium enhanced MRI previously, it will be confusing. Because delayed clearance and persistance of gadolinium on SAS may mimick the serious pathologies mentioned above. This case report highlights the interesting appearance of SAS in a patient with renal insufficiency who underwent previous contrast-enhanced neck MRI.

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