Harloff Andreas, Blazhenets Ganna, Fostitsch Johannes, Strecker Christoph, Dersch Rick, Mayerhofer Ernst, Meyer Philipp T
Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Faculty of Medicine, Breisacherstr. 64, 79106, Freiburg, Germany.
Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.
EJNMMI Res. 2024 Nov 21;14(1):116. doi: 10.1186/s13550-024-01180-9.
Symptoms in acute cerebral sinus venous thrombosis (CSVT) are highly variable, ranging from headaches to fatal stroke, and the basis for this high inter-individual variability is poorly understood. The present study aimed to assess whether acute CSVT significantly alters regional cerebral blood flow (CBF), if findings differ from CBF patterns know from large-artery occlusion in stroke, and whether the pattern of CBF alterations depends on clot location. Therefore, we retrospectively analyzed 12 patients with acute CSVT 10.6 ± 4.6 days after symptom onset and ten healthy volunteers who underwent [O]water PET (two scans each, 300 ± 14 MBq [O]water). Static image datasets (15-75 s after injection; normalized to cerebellum) reflecting relative CBF (rCBF) were analyzed using voxel- and region-of-interest-based analysis (AAL3-atlas). We mirrored datasets of patients with left-sided CSVT to harmonize the affected hemisphere.
Seven and five patients showed right- and left-sided CSVT, respectively. The superior sagittal sinus (SSS) was involved in 8/12 patients. CSVT patients had extensive rCBF deficits in the voxel-based analysis with accentuation in the right (ipsilateral) frontal cortex and caudate nucleus compared to controls, which were most pronounced in cortical areas in those with involvement of the SSS (8/12), and in subcortical areas in those without involvement of the SSS (4/12; p < 0.05, false discovery rate corrected). ROI-analysis demonstrated significant frontal (p = 0.01) and caudate nucleus (p = 0.008) rCBF deficits driven by patients with and without SSS occlusion, respectively.
[O]water PET was able to visualize characteristic patterns of impaired rCBF, which were different from intracranial large-artery occlusion in acute ischemic stroke, and exhibited substantial rCBF alterations depending on the involvement of the SSS. Our findings provide novel insights into the effects of disturbed venous drainage on CBF in acute CSVT, which may aid in understanding the pathophysiology, and guide future therapy of acute CSVT.
急性脑静脉窦血栓形成（CSVT）的症状高度多变，从头痛到致命性中风不等，而这种个体间高度变异性的原因尚不清楚。本研究旨在评估急性CSVT是否会显著改变局部脑血流量（CBF），其结果是否与中风中大动脉闭塞时的CBF模式不同，以及CBF改变模式是否取决于血栓位置。因此，我们回顾性分析了12例症状发作后1〇.6±4.6天的急性CSVT患者以及1〇名接受[〇]水PET检查的健康志愿者（每人进行两次扫描，3〇〇±14 MBq [〇]水）。使用基于体素和感兴趣区域的分析（AAL3图谱）对反映相对CBF（rCBF）的静态图像数据集（注射后15 - 75秒；以小脑为标准进行归一化）进行分析。我们对左侧CSVT患者的数据集进行镜像处理，以使受影响的半球一致。
分别有7例和5例患者表现为右侧和左侧CSVT。12例患者中有8例累及上矢状窦（SSS）。在基于体素的分析中，与对照组相比，CSVT患者存在广泛的rCBF降低，右侧（同侧）额叶皮质和尾状核更为明显，在累及SSS的患者中皮质区域最为显著（8/12），而在未累及SSS的患者中皮质下区域最为显著（4/12；P<〇.〇5，经错误发现率校正）。感兴趣区域分析表明，无论是否存在SSS闭塞，患者的额叶（P = 〇.〇1）和尾状核（P = 〇.〇〇8）rCBF均显著降低。
[〇]水PET能够显示受损rCBF的特征性模式，这与急性缺血性中风中的颅内大动脉闭塞不同，并且根据SSS的累及情况表现出显著的rCBF改变。我们的研究结果为急性CSVT中静脉引流受阻对CBF的影响提供了新的见解，这可能有助于理解其病理生理学，并指导急性CSVT的未来治疗。
