Keller E, Flacke S, Urbach H, Schild H H
Department of Radiology, University of Bonn, Germany.
Stroke. 1999 May;30(5):1144-6. doi: 10.1161/01.str.30.5.1144.
Diffusion-weighted (DWI) and perfusion-weighted (PI) MRI are highly sensitive techniques for early diagnosis of arterial infarction, but little data on venous cerebral ischemia are available. We describe a case in which DWI, PI, and fast T2-weighted sequences were performed in the acute phase of deep cerebral venous thrombosis (CVT).
An 11-year-old girl with Crohn's disease developed deep CVT in which extensive edema was shown in the deep gray matter on T2-weighted sequence images. Isotropic echo-planar DWI demonstrated a local augmentation of the apparent diffusion coefficient (1.1 to 1.6x10(-3) mm2/s), consistent with vasogenic edema. In dynamic contrast-enhanced PI, the regional cerebral blood volume was increased and the passage time of the contrast bolus was markedly prolonged. Clinically, the patient recovered totally after intravenous full-dose heparinization. T2 abnormalities, apparent diffusion coefficient values (0.8 to 0.92x10(-3) mm2/s), and brain perfusion alterations resolved without damage to brain tissue.
Unlike arterial infarction, DWI demonstrated vasogenic edema in a patient with deep CVT, which proved to be reversible in follow-up magnetic resonance imaging. PI showed areas with extensive venous congestion, but perfusion deficits were missing. Therefore, we believe that DWI and PI may play a role in detecting venous congestion in CVT and in prospective differentiation of vasogenic edema and venous infarction.
扩散加权（DWI）和灌注加权（PI）磁共振成像（MRI）是早期诊断动脉梗死的高度敏感技术，但关于脑静脉缺血的数据较少。我们描述了一例在大脑深部静脉血栓形成（CVT）急性期进行DWI、PI和快速T2加权序列检查的病例。
一名患有克罗恩病的11岁女孩发生了大脑深部CVT，T2加权序列图像显示深部灰质有广泛水肿。各向同性回波平面DWI显示表观扩散系数局部增加（1.1至1.6×10⁻³mm²/s），符合血管源性水肿。在动态对比增强PI中，局部脑血容量增加，对比剂团块的通过时间明显延长。临床上，患者在静脉全剂量肝素化后完全康复。T2异常、表观扩散系数值（0.8至0.92×10⁻³mm²/s）和脑灌注改变均消失，未对脑组织造成损害。
与动脉梗死不同，DWI在一名大脑深部CVT患者中显示出血管源性水肿，在后续磁共振成像中证明是可逆的。PI显示有广泛静脉充血的区域，但没有灌注缺损。因此，我们认为DWI和PI可能在检测CVT中的静脉充血以及血管源性水肿和静脉梗死的前瞻性鉴别中发挥作用。
