Helmi Ali, Chan Aimee, Towfighi Sohrab, Kapadia Anish, Perry James, Ironside Sarah, Machnowska Matylda, Symons Sean P, Fox Allan J, Sahgal Arjun, Maralani Pejman Jabehdar
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2019 May;125:e189-e197. doi: 10.1016/j.wneu.2019.01.039. Epub 2019 Jan 24.
Glioblastoma (GBM) is associated with increased risk of developing dural venous sinus thrombosis (DVST), which often goes undiagnosed as symptoms are readily attributed to tumor. The purpose of this study was to investigate the incidence of DVST, potential predictive features on imaging, complications, its effect on survival, and time of greatest risk for developing DVST.
A retrospective search of patients with GBM who had surgery followed by chemotherapy and/or radiation therapy between 2009 and 2015 at our institution was performed. Magnetic resonance imaging studies of the brain were reviewed on volumetric postgadolinium T1-weighted sequences for DVST. Tumors were characterized using the Visually Accessible REMBRANDT (Repository for Molecular Brain Neoplasia Data) Images classification, and identified thromboses were tracked for propagation, regression, or resolution. Statistical analyses were directed at identifying clinical predictors and survival differences between the DVST and no-DVST groups.
In total, 163 cases totaling 1637 scans, were reviewed; 12 patients (7.4%) developed DVST, of whom 11 presented with thrombus before any treatment. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratios were significantly associated with thrombus development (P = 0.02 and P = 0.02, respectively). In patients who developed DVST, thrombosis was more likely to develop ipsilateral to tumor side (P = 0.01) and was associated with a greater likelihood of developing extracranial venous thromboembolism (P = 0.012). There were no venous infarcts and no significant difference in survival between groups (P = 0.83).
Patients with GBM have increased risk of developing DVST, independent of surgical treatment or chemoradiation. DVST presence does not affect survival. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratio on preoperative imaging were the most significant predictors of DVST development.
胶质母细胞瘤（GBM）与硬脑膜静脉窦血栓形成（DVST）风险增加相关，由于症状往往归因于肿瘤，DVST常未被诊断出来。本研究的目的是调查DVST的发生率、影像学上的潜在预测特征、并发症、其对生存的影响以及发生DVST的最大风险时间。
对2009年至2015年期间在本机构接受手术，随后进行化疗和/或放疗的GBM患者进行回顾性检索。在钆增强T1加权容积序列上对脑部磁共振成像研究进行DVST评估。使用视觉可及的REMBRANDT（分子脑肿瘤数据储存库）图像分类对肿瘤进行特征描述，并对识别出的血栓进行传播、消退或溶解追踪。统计分析旨在确定DVST组和无DVST组之间的临床预测因素和生存差异。
共回顾了163例患者的1637次扫描；12例患者（7.4%）发生了DVST，其中11例在任何治疗前出现血栓。硬脑膜窦的肿瘤侵犯和更高的T1/液体衰减反转恢复比率与血栓形成显著相关（分别为P = 0.02和P = 0.02）。在发生DVST的患者中，血栓形成更可能发生在肿瘤同侧（P = 0.01），并且与发生颅外静脉血栓栓塞的可能性更大相关（P = 0.012）。没有静脉梗死，两组之间的生存无显著差异（P = 0.83）。
GBM患者发生DVST的风险增加，与手术治疗或放化疗无关。DVST的存在不影响生存。术前影像学上硬脑膜窦的肿瘤侵犯和更高的T1/液体衰减反转恢复比率是DVST发生的最显著预测因素。
