Zhou Li-Xin, Yao Ming, Cui Li-Ying, Li Ming-Li, Zhu Yi-Cheng, Ni Jun, Peng Bin
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China.
Front Neurol. 2017 Nov 30;8:648. doi: 10.3389/fneur.2017.00648. eCollection 2017.
Few studies have investigated structural imaging findings of cerebral venous thrombosis (CVT) in China. The structural imaging [head computed tomography (CT) and routine brain magnetic resonance imaging (MRI)] can assess any parenchymal lesion secondary to the venous thrombosis and reveal direct signs of intraluminal thrombus. In recent years, many patients can be diagnosed with CVT more rapidly and directly by structural imaging. The aim of the present study is to determine the performance of structural imaging in the diagnosis and outcome of CVT in a large cohort single center of Chinese patients.
We evaluated consecutive patients admitted to our hospital with CVT receiving structural imaging from 1991 to 2015. A neuroradiologist, blinded to clinical data, independently reviewed the structural imaging, including head CT and routine MRI for parenchymal lesions and signs of dural venous sinus thrombosis, as well as the MRV/DSA findings. The Clinical and laboratory data were reviewed and recorded for further analysis.
117 patients were included in this study, 68 (58.1%) were females. Parenchymal lesions were identified in 56.4% (66/117) of the patients on structural imaging, including focal edema in 30.8%, hemorrhage in 19.7%, and brain swelling in 4.3% of the patients. Patients with parenchymal lesions presented with more often seizures ( < 0.001) and less often headache ( = 0.049). Intraluminal thrombus within the sinuses or veins on structural imaging was found in 28.2% (33/117) of the patients. Patients with both intraluminal thrombus and parenchymal lesions on structural imaging had more acute onset ( = 0.01) and present more consciousness disturbance ( = 0.007).
Intracranial lesions on structural imaging are frequently found in patients with CVT. Patients with parenchymal lesions on structural imaging, especially with intraluminal thrombus simultaneously, tend to have a severe clinical picture and might lead to a devastating or fatal outcome. Structural imaging may help on early diagnosis and predict the poor outcome of CVT.
在中国，很少有研究调查脑静脉血栓形成（CVT）的结构影像学表现。结构影像学检查[头部计算机断层扫描（CT）和常规脑磁共振成像（MRI）]可以评估静脉血栓形成继发的任何实质病变，并显示管腔内血栓的直接征象。近年来，许多患者可以通过结构影像学更快、更直接地诊断出CVT。本研究的目的是确定在中国患者的大型队列单中心中，结构影像学在CVT诊断及预后方面的表现。
我们评估了1991年至2015年间因CVT入住我院并接受结构影像学检查的连续患者。一名对临床数据不知情的神经放射科医生独立审查结构影像学检查结果，包括头部CT和常规MRI，以检查实质病变和硬脑膜静脉窦血栓形成的征象，以及磁共振静脉血管造影（MRV）/数字减影血管造影（DSA）结果。对临床和实验室数据进行审查并记录，以进行进一步分析。
本研究共纳入117例患者，其中68例（58.1%）为女性。在结构影像学检查中，56.4%（66/√117）的患者发现有实质病变，其中30.8%的患者有局灶性水肿，19.7%的患者有出血，4.3%的患者有脑肿胀。有实质病变的患者癫痫发作更为常见（<0.001），而头痛则较少见（=√0.049）。在结构影像学检查中，28.2%（33/117）的患者在窦或静脉内发现管腔内血栓。结构影像学检查既有管腔内血栓又有实质病变的患者起病更急（=0.01），意识障碍更明显（=0.007）。
CVT患者在结构影像学检查中经常发现颅内病变。结构影像学检查有实质病变的患者，尤其是同时有管腔内血栓的患者，往往临床表现严重，可能导致灾难性或致命后果。结构影像学检查可能有助于CVT的早期诊断并预测其不良预后。
