White James Bradley, Kaufmann Timothy J, Kallmes David F
Department of Neurological Surgery, The Mayo Clinic, Rochester, MN, USA.
Neurocrit Care. 2008;8(2):290-2. doi: 10.1007/s12028-007-9032-0.
Magnetic resonance venography (MRV) is a non-invasive imaging modality that is used in many centers to supplant conventional cerebral digital subtraction angiography (DSA) for the diagnosis of dural venous sinus thrombosis.
We present the case of a pregnant female diagnosed with dural venous sinus thrombosis by serial time-of-flight (TOF) MRV examinations, and treated with long-term anticoagulation based on these examinations.
The appearance of the affected dural sinus did not change on MRV over the treatment period. The patient returned during follow-up with new-onset pulsatile tinnitus, which prompted us to perform DSA to exclude a dural arteriovenous fistula. DSA revealed that the segment of venous sinus diagnosed as thrombosed on MRV actually was patent but had a septation in its midsection.
We concluded that the patient did not have a venous sinus thrombosis at the time of MRV examinations but rather an anatomical variant mimicking a thrombosis, which would not have required any treatment. MRV, particularly TOF MRV, is limited by artifacts in correctly identifying vascular anatomy and pathology and should be interpreted carefully. DSA remains the reference standard for most vascular imaging.
磁共振静脉血管造影（MRV）是一种非侵入性成像方式，许多中心都用它来替代传统的脑数字减影血管造影（DSA）以诊断硬脑膜静脉窦血栓形成。
我们报告一例通过连续时间飞跃（TOF）MRV检查诊断为硬脑膜静脉窦血栓形成的孕妇病例，并基于这些检查对其进行长期抗凝治疗。
在治疗期间，受累硬脑膜窦在MRV上的表现没有变化。患者在随访期间因新发搏动性耳鸣复诊，这促使我们进行DSA检查以排除硬脑膜动静脉瘘。DSA显示，在MRV上诊断为血栓形成的静脉窦段实际上是通畅的，但在其中段有一个分隔。
我们得出结论，在进行MRV检查时，该患者没有静脉窦血栓形成，而是一种类似血栓形成的解剖变异，本不需要任何治疗。MRV，尤其是TOF MRV，在正确识别血管解剖结构和病理方面受伪影限制，应谨慎解读。DSA仍然是大多数血管成像的参考标准。
