磁共振影像对脑静脉窦血栓形成的诊断价值研究

doi:10.3969/j.issn.1006-7795.2022.01.013

摘要/Abstract

摘要： 目的通过分析血栓异常信号以及继发静脉性脑实质改变,探讨磁共振多对比加权序列(T1WI、T2WI、FLAIR、DWI以及TOF-MRV)在脑静脉窦血栓形成(cerebral venous thrombosis, CVT)中的诊断价值。方法本研究纳入怀疑有CVT入院的患者,由两名有经验的放射科医生分别在磁共振多序列对比加权图像上(T1WI、T2WI、FLAIR、DWI以及TOF-MRV)分析血栓信号异常改变,对上矢状窦、直窦、右侧横窦、右侧乙状窦、左侧横窦、左侧乙状窦、皮质浅静脉7个静脉节段进行双盲评价,分析磁共振各序列在患者水平及节段水平上的敏感度及特异度;记录脑实质异常改变特点以及患者治疗方式,并分析脑实质异常改变与血栓受累节段、接受血管内介入治疗的相关性。结果最终纳入22名患者,其中15名为CVT;7名为非CVT,累及血栓节段共56处。在患者水平上,T1WI、T2WI、FLAIR、DWI以及TOF-MRV的诊断敏感度分别为66.7%、86.7%、100.0%、46.7%以及100.0%;在脑静脉节段水平上,T1WI、T2WI、FLAIR、DWI以及TOF-MRV的敏感度分别为32.1%、57.1%、78.6%、19.6%以及91.1%;在15名CVT患者中,6名CVT患者(40%)出现了8处脑实质异常改变,病变主要分布在皮质及皮质下,位于静脉引流区;其中4处(50%)为出血性改变(出血性梗死、血肿),且病变侧表观扩散系数(apparent diffusion coefficient,ADC)值与对侧正常脑实质ADC值差异无统计学意义(P=0.583);在接受血管内治疗的6名CVT患者中,4名患者(66.7%)存在脑实质异常,另外2名患者(44.4%)脑实质正常。结论 TOF-MRV对CVT的诊断敏感度最高,其次为FLAIR和T2WI序列,另外,继发的静脉性脑实质改变在磁共振图像上具有一定的空间分布特点,识别这些特点或许有助于CVT的临床诊断与治疗决策的选择。

关键词: 脑静脉血栓, 静脉性脑梗死, 磁共振成像, 治疗

Abstract: Objective To investigate the diagnostic value of magnetic resonance imaging (MRI) multi-contrast weighted sequences (T1WI, T2WI, FLAIR, DWI and TOF-MRV) based on the signal characteristics of thrombosis and secondary venous parenchymal changes. Methods Patients suspected with cerebral venous thrombosis (CVT) were included in our study. Two experienced radiologists reviewed the abnormal signal of thrombus on MRI multi-contrast weighted sequences (T1WI, T2WI, FLAIR, DWI and TOF-MRV), respectively with double-blind evaluation of seven venous segments (superior sagittal sinus, straight sinus, right transverse sinus, right sigmoid sinus, left transverse sinus, left sigmoid sinus, and intracranial cortical vein). Then, the sensitivity and specificity of each MRI sequence on patient' level and segment' level were analyzed. The characteristics of abnormal cerebral parenchymal changes and the treatment of CVT patients were recorded. And the correlation between abnormal brain parenchymal changes and thrombosed segments and the endovascular interventions were analyzed.Results Fifteen of 22 patients were finally diagnosed with CVT and a total of 56 thrombosed segments were involved. (1) On patient' level, the sensitivity of T1WI, T2WI, FLAIR, DWI and TOF-MRV were 66.7%, 86.7%, 100.0%, 46.7% and 100.0%, respectively; On segment' level, the sensitivity of T1WI, T2WI, FLAIR, DWI and TOF-MRV were 32.1%, 57.1%, 78.6%, 19.6% and 91.1%, respectively. (2) In 15 CVT patients, 6 patients (40%) were with abnormal parenchyma change, which mainly located in cerebral cortex and subcortex of venous drainage area. Of these, 4 lesions (50%) were hemorrhagic (hemorrhagic infarction and hematoma). There was no difference in ADC values between lesion side and contralateral side (P=0.583). (3) Of the six patients with CVT received endovascular treatment, four patients (66.7%) had brain parenchymal abnormalities and the other two patients (44.4%) were normal in cerebral parenchymal. Conclusion TOF-MRV has the highest diagnostic sensitivity for CVT among conventional MRI sequences, followed by FLAIR and T2WI sequences. In addition, secondary venous brain parenchymal changes have certain spatial distribution characteristics on MRI images. Identification of these characteristics may help in the clinical diagnosis of CVT and the selection of treatment decisions.

Key words: cerebral venous thrombosis, venous infarct, magnetic resonance imaging (MRI), treatment

中图分类号:

R445

张慧博, 杨晓旭, 刘欣圆, 顾华, 王双坤, 杨旗. 磁共振影像对脑静脉窦血栓形成的诊断价值研究[J]. 首都医科大学学报, 2022, 43(1): 67-73.

Zhang Huibo, Yang Xiaoxu, Liu Xinyuan, Gu Hua, Wang Shuangkun, Yang Qi. Diagnostic value of magnetic resonance imaging for cerebral venous sinus thrombosis[J]. Journal of Capital Medical University, 2022, 43(1): 67-73.

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