Patel D, Machnowska M, Symons S, Yeung R, Fox A J, Aviv R I, Jabehdar Maralani P
From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
AJNR Am J Neuroradiol. 2016 Nov;37(11):2026-2032. doi: 10.3174/ajnr.A4843. Epub 2016 Jun 16.
Signs suggestive of unexpected dural venous sinus thrombosis are detectable on routine MR imaging studies without MRV. We assessed performance characteristics and interrater reliability of routine MR imaging for the diagnosis of dural venous sinus thrombosis, focusing on the superior sagittal, transverse, and sigmoid sinuses.
This case series included 350 patients with MRIs performed with contrast-enhanced MRV and 79 patients with routine MRIs performed within 48 hours of a CTV from 2008 to 2014 (total, = 429). Routine MR images were separated from the contrast-enhanced MRVs and CTVs. Three neuroradiologists, blinded to clinical data, independently reviewed the MRIs for signs of dural venous sinus thrombosis, including high signal on sagittal T1, loss of flow void on axial T2, high signal on FLAIR, high signal on DWI, increased susceptibility effects on T2*-weighted gradient recalled-echo imaging, and filling defects on axial contrast-enhanced spin-echo T1WI and/or volumetric gradient-echo T1WI. Two neuroradiologists independently reviewed contrast-enhanced MRVs and CTVs to determine the consensus gold standard. Interrater reliability was calculated by using the κ coefficient.
Contrast-enhanced MRV and CTV confirmed that dural venous sinus thrombosis was present in 72 of 429 cases (16.8%). The combination of routine MR sequences had an overall sensitivity of 79.2%, specificity of 89.9%, and moderate interrater reliability (κ = 0.50). The 3 readers did not have similar performance characteristics. 69.4% of positive cases had clinical suspicion of dural venous sinus thrombosis indicated on imaging requisition.
Routine MR images can suggest dural venous sinus thrombosis with high specificity in high-risk patients, even in cases without clinical suspicion.
在未进行磁共振静脉血管造影（MRV）的常规磁共振成像（MR）研究中，可检测到提示意外硬脑膜静脉窦血栓形成的征象。我们评估了常规MR成像对硬脑膜静脉窦血栓形成诊断的性能特征和阅片者间可靠性，重点关注上矢状窦、横窦和乙状窦。
本病例系列包括2008年至2014年期间接受增强MRV检查的350例患者以及在CT静脉成像（CTV）后48小时内接受常规MRI检查的79例患者（共429例）。常规MR图像与增强MRV和CTV图像分开。三名神经放射科医生在不知晓临床数据的情况下，独立审查MRI以寻找硬脑膜静脉窦血栓形成的征象，包括矢状位T1加权像上的高信号、轴位T2加权像上血流流空信号消失、液体衰减反转恢复序列（FLAIR）上高信号、扩散加权成像（DWI）上高信号、T2*加权梯度回波成像上磁化率效应增加以及轴位增强自旋回波T1加权像和/或容积梯度回波T1加权像上的充盈缺损。两名神经放射科医生独立审查增强MRV和CTV以确定一致的金标准。使用κ系数计算阅片者间可靠性。
增强MRV和CTV证实429例中有72例（16.8%）存在硬脑膜静脉窦血栓形成。常规MR序列组合的总体敏感性为79.2%，特异性为89.9%，阅片者间可靠性中等（κ = 0.50）。三位阅片者的表现特征不相似。69.4%的阳性病例在影像检查申请单上有硬脑膜静脉窦血栓形成的临床怀疑。
常规MR图像在高危患者中可高度特异性地提示硬脑膜静脉窦血栓形成，即使在无临床怀疑的病例中也是如此。
