Diagnostic value of magnetic resonance imaging for cerebral venous sinus thrombosis

doi:10.3969/j.issn.1006-7795.2022.01.013

Abstract

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

CLC Number:

R445

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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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2022.01.013

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2022/V43/I1/67

References

[1] Ferro J M, Aguiar De Sousa D. Cerebral venous thrombosis: an update[J]. Curr Neurol Neurosci Rep, 2019, 19(10): 74.
[2] Ferro J M, Canhão P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT)[J]. Stroke, 2004, 35(3): 664-670.
[3] Stam J. Thrombosis of the cerebral veins and sinuses[J]. N Engl J Med, 2005, 352(17): 1791-1798.
[4] Chiewvit P, Piyapittayanan S, Poungvarin N. Cerebral venous thrombosis: diagnosis dilemma[J]. Neurol Int, 2011, 3(3): e13.
[5] Ferro J M, Canhão P, Aguiar De Sousa D. Cerebral venous thrombosis[J]. Press Med, 2016, 45(12 Pt 2): e429-e450.
[6] Saposnik G, Barinagarrementeria F, Brown R D J, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2011, 42(4): 1158-1192.
[7] Leach J L, Fortuna R B, Jones B V, et al. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls[J]. Radiographics, 2006, 26(Suppl 1): S19-S41.
[8] Idbaih A, Boukobza M, Crassard I, et al. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images[J]. Stroke, 2006, 37(4): 991-995.
[9] Canedo-Antelo M, Baleato-González S, Mosqueira A J, et al. Radiologic clues to cerebral venous thrombosis[J]. Radiographics, 2019, 39(6): 1611-1628.
[10] Arnoux A, Triquenot-Bagan A, Andriuta D, et al. Imaging characteristics of venous parenchymal abnormalities[J]. Stroke, 2017, 48(12): 3258-3265.
[11] Altinkaya N, Demir S, Alkan O, et al. Diagnostic value of T2*-weighted gradient-echo MRI for segmental evaluation in cerebral venous sinus thrombosis[J]. Clin Imaging, 2015, 39(1): 15-19.
[12] Yang Q, Duan J G, Fan Z Y, et al. Early detection and quantification of cerebral venous thrombosis by magnetic resonance black-blood thrombus imaging[J]. Stroke, 2016, 47(2): 404-409.
[13] Sajjad Z. MRI and MRV in cerebral venous thrombosis[J]. J Pak Med Assoc, 2006, 56(11): 523-526.
[14] Poon C S, Chang J K, Swarnkar A, et al. Radiologic diagnosis of cerebral venous thrombosis: pictorial review[J]. AJR Am J Roentgenol, 2007, 189(Suppl 6): S64-S75.
[15] Renard D, Le Bars E, Arquizan C, et al. Time-of-flight MR angiography in cerebral venous sinus thrombosis[J]. Acta Neurol Belg, 2017, 117(4): 837-840.
[16] Krieger D A, Dehkharghani S. Magnetic resonance imaging in ischemic stroke and cerebral venous thrombosis[J]. Top Magn Reson Imaging, 2015, 24(6): 331-352.
[17] Favrole P, Guichard J P, Crassard I, et al. Diffusion-weighted imaging of intravascular clots in cerebral venous thrombosis[J]. Stroke, 2004, 35(1): 99-103.
[18] Schaller B, Graf R, Wienhard K, et al. A new animal model of cerebral venous infarction: ligation of the posterior part of the superior sagittal sinus in the cat[J]. Swiss Med Wkly, 2003, 133(29/30): 412-418.
[19] Schaller B, Graf R. Cerebral venous infarction: the pathophysiological concept[J]. Cerebrovasc Dis, 2004, 18(3): 179-188.
[20] Bergui M, Bradac G B, Daniele D. Brain lesions due to cerebral venous thrombosis do not correlate with sinus involvement[J]. Neuroradiology, 1999, 41(6): 419-424.
[21] Zubkov A Y, McBane R D, Brown R D, et al. Brain lesions in cerebral venous sinus thrombosis[J]. Stroke, 2009, 40(4): 1509-1511.
[22] Afifi K, Bellanger G, Buyck P J, et al. Features of intracranial hemorrhage in cerebral venous thrombosis[J]. J Neurol, 2020, 267(11): 3292-3298.
[23] Mullins M E, Grant P E, Wang B, et al. Parenchymal abnormalities associated with cerebral venous sinus thrombosis: assessment with diffusion-weighted MR imaging[J]. AJNR Am J Neuroradiol, 2004, 25(10): 1666-1675.
[24] Chu K, Kang D W, Yoon B W, et al. Diffusion-weighted magnetic resonance in cerebral venous thrombosis[J]. Arch Neurol, 2001, 58(10): 1569-1576.
[25] Doege C A, Tavakolian R, Kerskens C M, et al. Perfusion and diffusion magnetic resonance imaging in human cerebral venous thrombosis[J]. J Neurol, 2001, 248(7): 564-571.
[26] Röttger C, Trittmacher S, Gerriets T, et al. Reversible MR imaging abnormalities following cerebral venous thrombosis[J]. AJNR Am J Neuroradiol, 2005, 26(3): 607-613.
[27] Liao C H, Liao N C, Chen W H, et al. Endovascular mechanical thrombectomy and on-site chemical thrombolysis for severe cerebral venous sinus thrombosis[J]. Sci Rep, 2020, 10(1): 4937.
[28] Al Rawahi B, Almegren M, Carrier M. The efficacy and safety of anticoagulation in cerebral vein thrombosis: a systematic review and Meta-analysis[J]. Thromb Res, 2018, 169: 135-139.