Vogl T J, Bergman C, Villringer A, Einhäupl K, Lissner J, Felix R
Department of Radiology, Free University of Berlin, Rudolf Virchow Clinic, Germany.
AJR Am J Roentgenol. 1994 May;162(5):1191-8. doi: 10.2214/ajr.162.5.8166009.
The purpose of this study was to determine the value of venous MR angiography as the sole procedure for the diagnosis and follow-up of dural sinus thrombosis.
Forty-two patients with clinical findings suggestive of dural sinus thrombosis were examined with venous MR angiography and spin-echo MR imaging. Maximum-intensity-projection reconstructions and individual sections of the MR angiograms were examined for direct and indirect signs of dural sinus thrombosis by assessing flow signal from the major sinuses, the jugular bulb, upper jugular veins, ascending cortical veins (occlusion or increased flow due to formation of collaterals), diploe (emissary) veins and extracranial veins, and the deep subcortical veins (Galen's and internal cerebral veins). Direct signs of dural sinus thrombosis on MR angiograms included lack of typical high flow signal from a sinus that did not appear aplastic or hypoplastic on single sections from MR angiography and the frayed appearance of the flow signal from a sinus after recanalization. Indirect signs of dural sinus thrombosis included evidence of formation of collaterals, unusually prominent flow signal from deeper medullary veins, cerebral hemorrhage, visualization of emissary veins, and signs of increased intracranial pressure. When available, conventional angiograms were evaluated by analogous criteria as appropriate. Digital subtraction or cut-film angiograms were available for correlation in nine patients. In nine patients, MR angiography was repeated up to eight times during the course of follow-up. The results of MR angiography for all patients were compared with results in 10 control subjects. Confirmation of the diagnosis of dural sinus thrombosis was based either on conventional angiographic findings or on the changes seen in follow-up examinations.
Dural sinus thrombosis could be ruled out in 25 of the 42 patients on the basis of clinical and MR angiographic findings. In 17 patients with MR angiographic findings that indicated dural sinus thrombosis, conventional angiography confirmed the diagnosis in nine patients, and changes seen on repeat MR angiograms during follow-up confirmed the diagnosis in nine patients as well (one patient's diagnosis was confirmed by both techniques). Individual frames from two-dimensional fast low-angle shot sequences allowed direct visualization of thrombus. Limited spin-echo sequences as performed here provided inconsistent findings and were insufficient for diagnosis. In the 10 control subjects, attenuation of flow signal was seen in the torcular Herophili in all studies; one subject had a nonpathologic variant of the sinojugular system.
MR angiography is the technique of choice for diagnostic evaluation and follow-up of dural sinus thrombosis, and it is reliable as the sole examination for this condition. When MR angiographic findings are unremarkable and other abnormalities must be ruled out, routine spin-echo MR imaging should be performed.
本研究的目的是确定静脉磁共振血管造影作为诊断和随访硬脑膜窦血栓形成的唯一检查方法的价值。
对42例临床症状提示硬脑膜窦血栓形成的患者进行了静脉磁共振血管造影和自旋回波磁共振成像检查。通过评估主要静脉窦、颈静脉球、颈上静脉、皮质上升静脉（因侧支循环形成导致的闭塞或血流增加）、板障（导静脉）静脉和颅外静脉以及深部皮质下静脉（大脑大静脉和大脑内静脉）的血流信号，对磁共振血管造影的最大强度投影重建图像和各层面图像进行检查，以寻找硬脑膜窦血栓形成的直接和间接征象。磁共振血管造影上硬脑膜窦血栓形成的直接征象包括：在磁共振血管造影单一层面上未显示发育不全或发育不良的静脉窦缺乏典型的高血流信号，以及再通后静脉窦血流信号的毛糙外观。硬脑膜窦血栓形成的间接征象包括：侧支循环形成的证据、较深髓静脉异常突出的血流信号、脑出血、导静脉显影以及颅内压升高的征象。如有条件，对传统血管造影也采用类似标准进行评估。9例患者有数字减影或平片血管造影可供对照。9例患者在随访过程中重复进行了多达8次的磁共振血管造影检查。将所有患者的磁共振血管造影结果与10例对照者的结果进行比较。硬脑膜窦血栓形成的诊断依据传统血管造影结果或随访检查中发现的变化来确定。
根据临床和磁共振血管造影结果，42例患者中有25例可排除硬脑膜窦血栓形成。17例磁共振血管造影结果提示硬脑膜窦血栓形成的患者中，传统血管造影证实9例诊断，随访期间重复磁共振血管造影所见变化也证实9例诊断（1例患者的诊断由两种技术共同证实）。二维快速低角度激发序列的单帧图像可直接显示血栓。此处所采用的有限自旋回波序列结果不一致，不足以用于诊断。10例对照者中，所有检查均见窦汇处血流信号减弱；1例有颈静脉系统的非病理性变异。
磁共振血管造影是诊断评估和随访硬脑膜窦血栓形成的首选技术，作为针对该疾病的唯一检查方法是可靠的。当磁共振血管造影结果不明显且必须排除其他异常时，应进行常规自旋回波磁共振成像检查。
