Ries S, Steinke W, Neff K W, Hennerici M
Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany.
Stroke. 1997 Apr;28(4):696-700. doi: 10.1161/01.str.28.4.696.
Early diagnosis of cerebral transverse sinus venous thrombosis (TSVT) is difficult because of nonspecific and variable clinical presentations. Therefore, we evaluated the diagnostic value of transcranial color-coded duplex sonography (TCCS) after administration of an echocontrast-enhancing agent (cTCCS) in clinically suspected TSVT.
We examined 14 patients (6 men, 8 women; mean age, 48 years; range, 18 to 70 years) with signs and symptoms suggestive of cerebral TSVT. Color-coded signals from the contralateral transverse sinus were displayed transtemporally before and after injections of an echocontrast agent by TCCS. Sonographic findings were correlated with MRI and MR venography (MRV).
Before echocontrast enhancement, TCCS displayed color Doppler signals in 7 of 28 transverse sinus. Echocontrast TCCS obtained sufficient color signals in 27 of 28 transverse sinus. Thus, diagnostic confidence was achieved in all but 1 patient. In 13 patients, cTCCS identified 3 cases with symmetrical blood flow in the transverse sinus, which was confirmed by MRV. Accordingly, asymmetry of venous blood flow was correctly assessed by cTCCS in the other 10 patients. In 6 of these 10 patients, cTCCS demonstrated residual color flow signals, which on MRI/MRV corresponded to partial TSVT (4 cases) and to hypoplasia (1 case) of the transverse sinus. One case of complete thrombotic occlusion of the transverse sinus was missed by cTCCS because of color Doppler signals originating from an adjacent dural fistula. Echocontrast TCCS diagnosis of occlusion of a transverse sinus was confirmed by MRI/MRV in all cases (aplasia of transverse sinus, n = 1; complete TSVT, n = 3). Systolic peak flow velocities were significantly decreased in hypoplastic or partially occluded transverse sinus (9.4 +/- 4.0 cm/s) and significantly increased contralaterally (28.4 +/- 6.5 cm/s) with respect to patients with symmetrical appearance of the transverse sinus (17.5 +/- 1.9 cm/s) (P < .05).
TCCS examination of the cerebral venous system is difficult without contrast media application and almost useless for the study of TSVT. However, cTCCS is of practical value in the initial workup of patients with clinically suspected TSVT and may provide further insight for follow-up studies in view of monitoring the recanalization.
由于临床表现不特异且多变，脑横窦静脉血栓形成（TSVT）的早期诊断较为困难。因此，我们评估了在临床怀疑TSVT的患者中，经颅彩色编码双功超声（TCCS）在注射超声造影剂后（cTCCS）的诊断价值。
我们检查了14例有脑TSVT体征和症状的患者（6例男性，8例女性；平均年龄48岁；范围18至70岁）。通过TCCS在注射超声造影剂前后经颞部显示对侧横窦的彩色编码信号。超声检查结果与MRI和磁共振静脉血管造影（MRV）进行对比。
在超声造影增强前，TCCS在28个横窦中的7个显示了彩色多普勒信号。超声造影TCCS在28个横窦中的27个获得了足够的彩色信号。因此，除1例患者外，其余患者均获得了诊断信心。在13例患者中，cTCCS识别出3例横窦血流对称的病例，MRV证实了这一点。相应地，cTCCS正确评估了其他10例患者静脉血流的不对称性。在这10例患者中的6例中，cTCCS显示有残余彩色血流信号，在MRI/MRV上对应于部分TSVT（4例）和横窦发育不全（1例）。1例横窦完全血栓闭塞病例被cTCCS漏诊，因为彩色多普勒信号源自相邻的硬脑膜瘘。所有病例（横窦发育不全，n = 1；完全TSVT，n = 3）中，MRI/MRV均证实了超声造影TCCS对横窦闭塞的诊断。与横窦外观对称的患者（17.5 +/- 1.9 cm/s）相比，发育不全或部分闭塞的横窦收缩期峰值流速显著降低（9.4 +/- 4.0 cm/s），对侧显著升高（28.4 +/- 6.5 cm/s）（P <.05）。
在不应用造影剂的情况下，对脑静脉系统进行TCCS检查很困难，对TSVT的研究几乎没有用处。然而，cTCCS在临床怀疑TSVT患者的初始检查中具有实用价值，并且鉴于监测再通情况，可能为后续研究提供进一步的见解。
