Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India.
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neruosciences, Bangalore, India.
J Clin Neurosci. 2023 Nov;117:54-60. doi: 10.1016/j.jocn.2023.09.007. Epub 2023 Sep 26.
Mastoid air cell abnormalities in the form of hyperintense T2 fluid signal have been reported in cases of acute Cerebral Venous Thrombosis (CVT) without otologic infection and have been hypothesized to be a result of venous congestion rather than infectious mastoiditis. The aim of this study was to investigate a link between the spectrum of mastoid abnormalities and clot burden in patients with acute CVT.
A retrospective study of adult patients admitted to the National Institute of Mental Health and Neurosciences between 2016 and 2023 who were diagnosed with acute CVT and had no clinical evidence of active or recent ear infections was conducted. Pre- and post-contrast MR Images were analyzed to identify the dural sinuses and/or cerebral veins involved and the presence of fluid signal in the mastoid. Fluid signal in the mastoid was graded from 0 to 3 as described by Shah et al- no fluid signal (grade 0), thin curvilinear hyperintensities (grade 1), thick crescenteric hyperintensities (grade 2), and complete hyperintensity (grade 3). Clot Burden Score (CBS) was calculated by assigning one point for each sinus involved, one point for extension of thrombus into the intracranial Internal Jugular Vein (IJV), one point for thrombosis of cortical veins and one point for thrombosis of deep cerebral veins.
A total of 89 patients with acute CVT were included in the final analysis. Median time from presentation to MRI was 2 days (range 0-13). 51 patients (57.3%) had fluid signal in the mastoid air cells on T2-weighted images, of whom 33 showed mucosal contrast enhancement. Higher grade of fluid signal in the mastoid was present ipsilateral to the side of venous thrombosis in 59 out of 60 patients with posterior fossa CVT. CBS was significantly different between patients with different grades of fluid signal (p = 0.002). Grade 2-3 fluid signal was associated with higher clot burden (CBS > 3) in both the entire study population (n = 89) - OR = 8.281, 95 %CI: 2.758-24.866 (p < 0.001) and among patients with posterior fossa CVT - OR = 4.375, 95 %CI: 1.320-14.504 (p = 0.016). Among patients with posterior fossa CVT, grade 2-3 fluid signal was associated with left sided transverse and/or sigmoid sinus thrombosis - OR = 5.600, 95 %CI: 1.413-22.188 (p = 0.014), and extension of thrombosis into the IJV - OR = 4.606, 95 %CI: 1.162-18.262 (p = 0.030).
T2 fluid signal in the mastoid is associated with venous congestion in adults with acute CVT without evidence of otologic infection. Moderate-to-severe T2 fluid signal in the mastoid air cells is associated with increased clot burden.
在没有耳感染的急性脑静脉血栓形成（CVT）病例中，已经报道了乳突气房异常的 T2 液体信号呈高信号，据推测这是静脉充血的结果，而不是感染性乳突炎。本研究的目的是探讨急性 CVT 患者乳突异常与血栓负荷之间的关系。
对 2016 年至 2023 年期间在印度国家心理健康和神经科学研究所住院的、诊断为急性 CVT 且无临床证据表明有活动性或近期耳部感染的成年患者进行了一项回顾性研究。分析了对比前和对比后的磁共振成像，以确定受累的硬脑膜窦和/或脑静脉以及乳突内液体信号的存在。乳突内液体信号按照 Shah 等人描述的从 0 到 3 级进行分级-无液体信号（等级 0）、细曲线形高信号（等级 1）、厚新月形高信号（等级 2）和完全高信号（等级 3）。血栓负荷评分（CBS）通过为每个受累的窦计算 1 分、为血栓延伸至颅内颈内静脉（IJV）计算 1 分、为皮质静脉血栓形成计算 1 分和为深部脑静脉血栓形成计算 1 分来计算。
最终共有 89 例急性 CVT 患者纳入最终分析。从发病到 MRI 的中位时间为 2 天（范围 0-13 天）。51 例（57.3%）患者的 T2 加权图像上显示乳突气房有液体信号，其中 33 例有黏膜对比增强。在 60 例后颅窝 CVT 患者中，59 例乳突气房液体信号较高的同侧有静脉血栓形成。不同等级的乳突内液体信号的 CBS 存在显著差异（p=0.002）。在整个研究人群（n=89）中，等级 2-3 的液体信号与更高的血栓负荷（CBS>3）相关-OR=8.281，95%CI：2.758-24.866（p<0.001），在后颅窝 CVT 患者中，OR=4.375，95%CI：1.320-14.504（p=0.016）。在后颅窝 CVT 患者中，等级 2-3 的液体信号与左侧横窦和/或乙状窦血栓形成相关-OR=5.600，95%CI：1.413-22.188（p=0.014），以及血栓延伸至 IJV-OR=4.606，95%CI：1.162-18.262（p=0.030）。
在没有耳感染证据的急性 CVT 成人中，乳突 T2 液体信号与静脉充血有关。乳突气房内中度至重度 T2 液体信号与血栓负荷增加有关。
