Department of Radiology, Bichat Hospital, 55076Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Adult Radiology, 26930Hôpital Necker, Paris, France.
Neuroradiol J. 2023 Apr;36(2):148-157. doi: 10.1177/19714009221109885. Epub 2022 Jun 18.
To assess the diagnostic accuracy and lesion conspicuity of susceptibility-weighted angiography (SWAN) and T2* for the clot detection in acute cerebral venous thrombosis (CVT) by comparison with contrast-enhanced MR venography.
Venous thrombi detection and conspicuity were assessed by two readers for 18 venous segments on both T2*, SWAN source images, 2D SWAN reformats matching with T2*, and 3D SWAN images (SWAN-MinIP). Images obtained with the three reading techniques were systematically scored and compared to CE MRV findings, in a blinded fashion, per patient and per segment, and compared to each other.
In 30 patients, 137 thrombosed venous segments were evaluated. The sensitivity of T2*, SWAN source images, 2D SWAN, and SWAN MinIP were, respectively, of 89.3%/82.1%, 82.1%, and 82.1% for dural sinus thrombosis and of 100%/100%/100%/96.6% for cortical venous thrombosis. There were significant differences in thrombus detection between T2* and SWAN: T2* versus SWAN source images and 2D SWAN ( = 0.04) and versus SWAN MinIP ( = 0.03). There were no significant differences between the three modalities of SWAN images. T2* was more sensitive than all SWAN images for both sigmoid sinus thrombosis and intracranial internal jugular vein thrombosis ( = 0.04). Inter-observer agreement was slightly superior with T2* ( < 0.05).
In this small cohort, SWAN sequence at 3T did not yield additional value for thrombus detection in acute CVT compared to T2*. This study highlights SWAN's greatest weakness both for diagnostic accuracy and lesion conspicuity compared to T2* for acute venous clot detection near the skull base.
通过与对比增强磁共振静脉造影（CE MRV）比较，评估磁敏感加权血管成像（SWAN）和 T2*对急性脑静脉血栓形成（CVT）中血栓的诊断准确性和病灶显示能力。
两位读者评估了 18 个静脉段的静脉血栓检测和显影效果，这些静脉段分别位于 T2*、SWAN 原始图像、与 T2*匹配的 2D SWAN 重建图像和 3D SWAN 图像（SWAN-MinIP）上。对三种阅读技术的图像进行系统评分，并在盲法下对每个患者和每个静脉段的结果与 CE MRV 结果进行比较，并相互比较。
在 30 例患者中，评估了 137 个血栓形成的静脉段。T2*、SWAN 原始图像、2D SWAN 和 SWAN MinIP 的敏感性分别为硬脑膜窦血栓形成的 89.3%/82.1%、82.1%和 82.1%，皮质静脉血栓形成的 100%/100%/100%/96.6%。T2与 SWAN 之间在血栓检测方面存在显著差异：T2与 SWAN 原始图像和 2D SWAN（=0.04）以及与 SWAN MinIP（=0.03）之间。三种 SWAN 图像之间没有显著差异。对于乙状窦血栓形成和颅内颈内静脉血栓形成，T2的敏感性均高于所有 SWAN 图像（=0.04）。T2的观察者间一致性略优于 SWAN（<0.05）。
在本小队列中，与 T2相比，3T 时的 SWAN 序列在急性 CVT 中对血栓检测没有额外价值。本研究突出了 SWAN 的最大弱点，即与 T2相比，在检测颅底附近急性静脉血栓时，SWAN 的诊断准确性和病灶显示能力均较差。
