Sari Sebahattin, Verim Samet, Hamcan Salih, Battal Bilal, Akgun Veysel, Akgun Hakan, Celikkanat Serhat, Tasar Mustafa
Gulhane Military Medical School, Department of Radiology, Ankara, Turkey.
Ankara Mevki Military Hospital, Department of Radiology, Ankara, Turkey.
Clin Neurol Neurosurg. 2015 Jul;134:44-54. doi: 10.1016/j.clineuro.2015.04.013. Epub 2015 Apr 22.
Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage.
We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21-70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated.
Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction.
Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis.
主要目的是比较对比增强三维梯度回波T1加权序列与非增强磁共振静脉血管造影及传统磁共振成像（MRI）在检测硬脑膜静脉窦（DVS）和皮质静脉血栓形成方面的诊断价值；次要目的是确定DVS血栓形成/部位与性别、年龄、梗死或出血之间的关系。
我们回顾性分析了30例临床怀疑DVS血栓形成患者（17例男性，13例女性，年龄21 - 70岁，平均年龄40.1岁）的传统MR图像、非增强MR静脉血管造影图像以及对比增强后即刻的三维梯度回波T1加权MR图像。MR检查使用1.5T或3T MR扫描仪进行。对包括皮质静脉在内的10个亚段的DVS进行评估。每组MR图像分别进行检查，检查者对最终诊断不知情。记录相关发现，并计算每种MRI技术的敏感性、特异性和准确性。
30例患者中有24例（80%）最终诊断为皮质静脉和/或硬脑膜窦血栓形成，300个节段中有67个（22.3%）存在血栓形成。对于血栓形成节段的检测，传统MR序列的敏感性、特异性和准确性分别为83.6%、95.3%和92.7%，非增强MR静脉血管造影分别为89.6%、91.8%和91.3%，对比增强三维梯度回波T1加权序列分别为92.5%、100%和98.3%。皮质静脉血栓形成的病例中梗死和出血更为常见，而性别和年龄与DVS血栓形成或其部位无显著关系。传统MR序列和非增强MR静脉血管造影在某些孤立皮质静脉血栓形成、血栓物质呈高信号以及伴有出血或梗死的病例中，因其提供的额外信息而有帮助。
对比增强三维梯度回波T1加权MRI是检测DVS和/或皮质静脉血栓形成最准确的成像方法。皮质静脉血栓形成的病例中梗死和出血更为常见。
