Renard Dimitri, Le Bars Emmanuelle, Arquizan Caroline, Gaillard Nicolas, de Champfleur Nicolas Menjot, Mourand Isabelle
Department of Neurology, Nîmes University Hospital, 4 Rue du Pr Debré, 30029, Nîmes Cedex 4, France.
Department of Neurororadiology, Institut d, Imagerie Fonctionnelle Humaine, Montpellier University Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
Acta Neurol Belg. 2017 Dec;117(4):837-840. doi: 10.1007/s13760-017-0835-2. Epub 2017 Sep 21.
Recently, time-of-flight (TOF) and gadolinium-enhanced MR angiography (MRA) imaging have been used to demonstrate subacute intramural hematoma in cervical artery dissection and to detect intraplaque haemorrhage. Our aim was to perform an exploratory study to analyse if venous thrombus-related signal changes (potentially showing iso- or hyperintensity) in cerebral venous sinus thrombosis (CVST) could be observed on 3D-TOF MRA imaging. We analysed retrospectively MRIs of CVST patients in whom both contrast-enhanced MR venography (CEMRV) and 3D-TOF sequences were performed in the acute/subacute phase (i.e. < 31 days after symptom onset). The occluded sinus segments were defined on CEMRV. First, analyses of signal changes in occluded venous sinuses segments (defined by and unblinded to CEMRV) on native 3D-TOF images and morphological MRI sequences were performed. Second, a blinded (to CEMRV and other morphological MRI sequences) analysis was performed on 3D-TOF imaging assessing signal changes on 3D-TOF considering all sinus segments. Twenty-five CVST patients were included. 3D-TOF imaging showed signal changes (most often hyperintensity and less often isointensity) in 84% of the occluded sinus segments. Signal changes were observed in 91% of the occluded sinus segments on T1-weighted imaging, in 69% on T2-weighted imaging, in 68% on FLAIR, in 32% on DWI, and in 55% on T2*-weighted imaging. On blinded analysis, sensitivity of 3D-TOF sequences decreased to 80%, whereas specificity was only 65%. Abnormal signal in the venous sinuses on 3D-TOF may possibly help to suspect CVST, especially when CEMRV sequences lack.
最近，飞行时间（TOF）和钆增强磁共振血管造影（MRA）成像已被用于显示颈内动脉夹层的亚急性壁内血肿并检测斑块内出血。我们的目的是进行一项探索性研究，分析在三维时间飞跃（3D-TOF）MRA成像上是否能观察到脑静脉窦血栓形成（CVST）中与静脉血栓相关的信号变化（可能表现为等信号或高信号）。我们回顾性分析了在急性期/亚急性期（即症状出现后<31天）同时进行了对比增强磁共振静脉造影（CEMRV）和3D-TOF序列检查的CVST患者的磁共振成像（MRI）。在CEMRV上确定闭塞的静脉窦段。首先，对原始3D-TOF图像和形态学MRI序列上闭塞静脉窦段（由CEMRV定义且未设盲）的信号变化进行分析。其次，对3D-TOF成像进行设盲分析（对CEMRV和其他形态学MRI序列设盲），评估考虑所有静脉窦段时3D-TOF上的信号变化。纳入了25例CVST患者。3D-TOF成像显示84%的闭塞静脉窦段有信号变化（最常见为高信号，较少见为等信号）。在T1加权成像上，91%的闭塞静脉窦段观察到信号变化；在T2加权成像上为69%；在液体衰减反转恢复序列（FLAIR）上为68%；在扩散加权成像（DWI）上为32%；在T2*加权成像上为55%。在设盲分析中，3D-TOF序列的敏感性降至80%，而特异性仅为65%。3D-TOF上静脉窦的异常信号可能有助于怀疑CVST，尤其是在缺乏CEMRV序列时。
