So Tiffany Y, Dixon Andrew, Kavnoudias Helen, Paul Eldho, Maclaurin William
Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2019 Jun;63(3):311-317. doi: 10.1111/1754-9485.12865. Epub 2019 Mar 15.
The aim of this study was to assess the association between intrasinus gas and dural venous sinus thrombosis (DVST) in patients with blunt head trauma.
One hundred and two consecutive patients with blunt head trauma imaged with non-enhanced CT and CT head venography at our institution between 1 July 2011 and 30 June 2016 were included. Image review was performed by two independent reviewers to assess for the presence of intrasinus or perisinus gas and DVST. Skull fractures involving a dural venous sinus, sinus hyperdensity, extraaxial haematoma, and/or extrinsic dural venous sinus compression were also recorded. Univariate and multivariate analyses estimated the associations between the imaging variables and DVST.
Thirty-seven cases of DVST were confirmed with CT venography: 10 (27.0%) occlusive, and 27 (73.0%) non-occlusive. We detected 24 cases of intrasinus gas, all occurring with skull fractures. Gas localized to the sinus involved by the fracture in 23 (95.8%) of 24 cases. Additional gas within a contiguous sinus was present in nine (37.5%) cases. The association between intrasinus gas and DVST of the respective sinus was statistically significant (OR: 11.3, CI: 3.9-32.9, P < 0.0001). DVST was also significantly associated with the presence of a skull fracture (P = 0.04), fractures involving the sigmoid sinus (P = 0.0001), and sinus hyperdensity (P < 0.0001).
Traumatic intrasinus gas is associated with DVST in patients with blunt head trauma. Its detection on non-enhanced CT examinations in the emergency care setting infers a higher risk of DVST and should prompt consideration of CT venography.
本研究旨在评估钝性头部外伤患者鼻窦内气体与硬脑膜静脉窦血栓形成（DVST）之间的关联。
纳入2011年7月1日至2016年6月30日期间在我院接受非增强CT和CT脑静脉造影检查的102例连续钝性头部外伤患者。由两名独立的阅片者进行图像评估，以确定是否存在鼻窦内或鼻窦周围气体以及DVST。还记录了涉及硬脑膜静脉窦的颅骨骨折、鼻窦高密度影、轴外血肿和/或硬脑膜静脉窦外部压迫情况。单因素和多因素分析评估了影像变量与DVST之间的关联。
CT静脉造影确诊37例DVST：10例（27.0%）为闭塞性，27例（73.0%）为非闭塞性。我们检测到24例鼻窦内气体，均与颅骨骨折有关。24例中有23例（95.8%）气体局限于骨折累及的鼻窦。9例（37.5%）患者相邻鼻窦内有额外气体。各鼻窦内气体与DVST之间的关联具有统计学意义（OR：11.3，CI：3.9 - 32.9，P < 0.0001）。DVST还与颅骨骨折（P = 0.04）、累及乙状窦的骨折（P = 0.0001）以及鼻窦高密度影（P < 0.0001）显著相关。
钝性头部外伤患者中，外伤性鼻窦内气体与DVST有关。在急诊环境下非增强CT检查中检测到该气体提示DVST风险较高，应促使考虑进行CT静脉造影。
