Jacków-Nowicka Jagoda, Jagiełło Jacek, Dziadkowiak Edyta, Bladowska Joanna, Sąsiadek Marek, Zimny Anna
Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.
Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.
Pol J Radiol. 2021 Oct 8;86:e574-e582. doi: 10.5114/pjr.2021.109490. eCollection 2021.
Acute cerebral venous thrombosis (CVT) is a rare condition that can lead to a serious clinical state; thus, prompt diagnosis and treatment are mandatory. Head computed tomography (CT) plays a crucial role in the initial prompt diagnosis in the emergency setting. The aim of the study was to retrospectively analyse emergency head CT studies and the rate of incorrect diagnoses and main sources of pitfalls.
Retrospective analysis of 31 emergency CT studies (22 without contrast, 19F/12M, age range: 4-94 years) of patients with confirmed acute CVT.
Thrombosed dural sinuses were found in 24/31 (77.4%) cases, thrombosed veins in 7/31 (22.6%) cases, no lesions within vessels in 2/31 (6.5%) cases. Haemorrhagic brain lesions were found in 9/31 (29%) cases, hypodense oedema in 6/31 (19.6%) cases, brain swelling in 1/31 (3.2%) cases, and no parenchymal lesions were revealed in 15/31 (48.4%) cases. Correct diagnosis of CVT was established in 15 cases (48.4%); however, it was incorrect in 16 cases (51.6%). Incorrect cases consist of 4 groups: 1 - with both vascular and parenchymal lesions that were overlooked (50%), 2 - with vascular lesions only, which were either overlooked, misinterpreted, or covered by artefacts (31.3%,), 3 - with parenchymal lesions only, which were misinterpreted (12.5%), and 4 - with no lesions present in the emergency head CT (6.2%).
The high rate of incorrect diagnoses of acute CVT based on emergency head CT requires constant training of radiologists and their close cooperation with clinicians because a delayed diagnosis may be lethal to the patient.
急性脑静脉血栓形成（CVT）是一种罕见疾病，可导致严重的临床状态；因此，必须及时诊断和治疗。头部计算机断层扫描（CT）在急诊情况下的初始快速诊断中起着关键作用。本研究的目的是回顾性分析急诊头部CT检查以及误诊率和陷阱的主要来源。
对31例确诊为急性CVT患者的急诊CT检查（22例平扫，19例女性/12例男性，年龄范围：4 - 94岁）进行回顾性分析。
31例中有24例（77.4%）发现硬脑膜窦血栓形成，7例（22.6%）发现静脉血栓形成，2例（6.5%）血管内无病变。31例中有9例（29%）发现出血性脑病变，6例（19.6%）发现低密度水肿，1例（3.2%）发现脑肿胀，15例（48.4%）未发现实质病变。15例（48.4%）正确诊断为CVT；然而，16例（51.6%）诊断错误。错误病例分为4组：1 - 同时存在被忽视的血管和实质病变（50%），2 - 仅存在被忽视、误判或被伪影掩盖的血管病变（31.3%），3 - 仅存在被误判的实质病变（12.5%），4 - 急诊头部CT未发现病变（6.2%）。
基于急诊头部CT对急性CVT的误诊率较高，这需要对放射科医生进行持续培训，并使其与临床医生密切合作，因为延迟诊断可能对患者致命。
