Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases

Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors. Received: 9 January 2001/Accepted: 10 January 2001     

硬膜窦血栓形成的MRI表现(附6例分析)

目的：探讨硬膜窦血栓形成的ＭＲＩ表现。方法：６例硬膜窦血栓形成，均做了ＭＲＩ检查，其中２例用了ＳＴＩＲ，１例用了ＦＬＡＩＲ序列，３例作了增强检查（Ｇｄ－ＤＴＰＡ），５例作了ＭＲＶ。结果：右横窦栓塞２例，左横窦１例，上矢状窦３例，脑肿胀５例，静脉性脑栓塞２例，脑血肿１例。增强检查，脑皮质及皮质静脉增强１例。结论：ＭＲＩ对硬膜窦血栓形成的诊断有独特的价值。硬膜窦流空信号消失和硬膜窦狭窄、闭塞是直接征像。脑肿胀、静脉性脑梗塞、脑血肿是间接征像     

Follow-up MRI in dural arteriovenous malformations involving the cavernous sinus: emphasis on detection of venous thrombosis

Summary Six patients with a dural arteriovenous malformation (dural AVM) involving the cavernous sinus were followed up with magnetic resonance imaging in order to assess change in the lesions. Spin-echo (SE) imaging of three patients in whom the AVM appeared to have closed at least 1 month earlier (two of them spontaneously, and one after external carotid artery embolization) showed neither apparent flow void in the involved cavernous sinus nor evidence of venous thrombosis. SE images of the other three patients who had not been cured by external carotid artery embolization (two of whom were examined within a week of treatment), detected persisting arteriovenous shunts, including high-flow cortical venous drainage, seen as flow void. Two-dimensional time-of-flight MR angiography (2D TOF MRA) was performed simultaneously in three patients. Whereas shunting blood and the normal cavernous sinus were of high intensity, presumed thrombosed cavernous sinuses were isointense with stationary brain tissue. SE imaging can confirm the resolution of arteriovenous shunts, but poorly delineates ver acute and chronic thrombosis of the draining veins. In contrast, 2D TOF MRA directly demonstrates flowing blood, permitting the diagnosis of venous thrombosis; it should be included in follow-up of a dural AVM involving the cavernous sinus when venous thrombosis is suspected.     

Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis

The aim of this study was to examine the reliability of single-slice phase-contrast angiography (SSPCA) as a rapid technique for the investigation of suspected dural venous sinus occlusion. Images were obtained on 25 normal volunteers to document the accuracy of SSPCA in the demonstration of slow flow states. Normal volunteers were imaged using sagittal and coronal SSPCA (slice thickness 13 cm, matrix 256 × 256, TR 14 ms, TE 7 ms, flip angle 20 °, peak velocity encoding rate 30 cm/s). Sinus patency and flow rate were confirmed by measurement of flow in the superior sagittal and transverse sinuses using quantified single-slice phase difference images. Imaging was performed in 50 patients undergoing routine brain scans in order to determine the optimal slice orientation for clinical use. Twenty-one patients with suspected dural venous sinus thrombosis were also investigated with SSPCA and the diagnosis confirmed by one or more alternative imaging techniques. Imaging time was 29 s per acquisition and image quality was good in all cases. Variations in dural sinus patency and flow in normal volunteers were accurately predicted by SSPCA (kappa = 0.92). Use of a single angulated slice (130 mm thick, para-sagittal image angled 30 ° towards coronal and 30 ° towards transverse) provided sufficient separation of right- and left-sided venous structures to allow use of a single projection. The presence and extent of sinus occlusions in 14 patients and the absence of thrombosis in 7 were accurately identified by SSPCA. Sensitivity and specificity in this limited study were both 100 %. The SSPCA technique takes less than 30 s and provides a reliable and rapid technique for the diagnosis of dural venous sinus thrombosis. Received: 10 July 1998; Revision received: 16 November 1998; Accepted: 11 January 1999     

MRI结合MRV对颅内静脉窦血栓的诊断价值

目的：探讨颅内静脉窦血栓的MRI及MRV诊断价值。方法：收集13例经临床证实的颅内静脉窦血栓患者,均做MRI及MRV检查,分析MRI及MRV在该病中的应用价值。结果：MRI平扫中见正常的静脉窦流空信号消失,增强MRI见空三角征,MRV见静脉窦闭塞。结论：MRI及MRV是颅内静脉窦血栓形成的最佳诊断手段。     

Isolated inferior sagittal sinus thrombosis: a case report

We present a case of isolated inferior sagittal sinus thrombosis shown on CT, MRI and angiography. This condition has not, to our knowledge, been described previously. Received: 17 June 1996 Accepted: 13 August 1996     

MRI assessment of unsuspected dural sinus thrombosis

Summary In three patients with clinically unsuspected diagnosis, MRI has afforded a positive and conspicuous demonstration of dural sinus thrombosis, allowing specific treatment and followed by improvement in the patients' condition. Even in retrospect, CT examinations were nondiagnostic. Presenting symptoms were usual and nonspecific. CT and radionuclide scanning have proved valuable when performed on a clinically oriented basis. Angiography cannot be carried out without clear indications. MRI offers advantages in being a non-invasive technique without ionising radiation, allowing direct visualization and accurate delineation of the thrombus. MRI is definitely the method of choice to assess clinically suspected cerebral venous occlusion. As MR diagnosis relies on a routine examination protocol, we believe that it will detect other unsuspected cases of dural sinus thrombosis.     

脑静脉窦血栓形成的MRI诊断(附15例分析)

目的 :探讨MRI对脑静脉窦血栓 (VST)的诊断价值。方法 :回顾性分析 15例VST患者的完整临床和影像学资料。全部行MR检查 ,其中 9例行增强扫描 ,8例行脑静脉MRA检查 ;12例曾行CT检查 ,其中 4例行增强扫描。结果 :上矢状窦受累 12例合并横窦血栓 11例 ,窦汇 7例、乙状窦 6例、下矢状窦、直窦受累 6例 ,海绵窦受累 1例。血栓在T1WI上均呈等、高不均匀信号 ,并出现脑组织肿胀 ,脑沟变浅 ,脑回模糊 ,在T2 WI上信号因发病时间不同而有所不同 ,8例T2 WI脑实质无异常信号 ,7例T2 WI脑实质出现异常信号。增强扫描 9例全部出现静脉异常强化。MRA表现为受累静脉窦信号较淡、边缘模糊且不规则的血流信号或血流信号完全消失。 12例CT检查中 2例见“空delta征” ,4例表现为梗塞、出血等不典型改变。结论 :MRI是诊断VST的首选检查方法 ,并对VST的预后评价有重要意义     

Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.     

脑静脉窦血栓磁共振血流成像的诊断价值

目的：探讨脑静脉磁共振血流成像在诊断脑静脉窦血栓中的应用价值。材料与方法：１２例脑静脉窦患者均作ＭＲＩ和脑静脉窦ＭＲＡ检查（３例治疗后随诊），８例行静脉期脑血管造影；与常规ＳＥ图像和Ｘ线脑血管造影对照，着重分析脑静脉ＭＲＡ在本病中的诊断价值。结果：受累的静脉窦有上矢状窦６例，窦汇（部分）８例，横窦８例（１０个），乙状窦８例（９个），直窦６例，大脑大静脉３例和大脑内静脉３例（６个）；脑静脉窦血栓ＭＲＡ直接征象为发育正常的静脉窦高血流信号缺失或再通形成的边缘模糊且不规则的较低血流信号，间接征象有病变以远静脉侧支形成或其他途径引流静脉异常扩张。结论：脑静脉窦ＭＲＡ及其原始图像在脑静脉窦血栓诊断及随诊中有独特价值，它比常规ＳＥ图像能提供更多的诊断信息，可直接显示静脉窦血栓，易于治疗后反复随诊，这些是血管造影所不及的。     

脑静脉窦及深静脉血栓的CT、MRI诊断

目的:探讨脑静脉窦及深静脉血栓的CT和MRI表现及诊断价值。方法:回顾性分析17例脑静脉窦及深静脉血栓患者的CT和MRI表现特点。结果:CT表现为静脉窦密度略高信号增高、窦腔增宽(n=5/12),增强扫描可见“空三角”征(n=3/3);随着病程的改变,MRI可表现为静脉窦T1WI(n=15/17),T2WI(n=13/17)流空效应消失,磁共振静脉成像(MRV)及增强MRV可显示静脉窦闭塞及静脉窦内充盈缺损(n=17/17;n=4/4);CT及MRI还可见皮层及皮层下多发、散在的出血性脑梗塞(n=7/12;n=13/17),基底节区脑梗塞(n=3/12;n=4/17)等间接征象。结论:CT增强可以显示静脉窦血栓,MRI、MRV及增强MRV相结合能准确地诊断脑静脉窦及深静脉血栓,MRI优于CT平扫。     

脑静脉窦血栓形成的MRI诊断

目的 :探讨MRI和MR血管成像 (MRA ,MRV)对脑静脉窦血栓形成 (CVST)的诊断价值。方法 :回顾性分析 10例CVST患者的临床和影像资料。全部病例行常规MRI和MRA( 3DTOF)、MRV( 2DTOF)检查 ,其中 9例行增强扫描。结果 :MR常规扫描示脑实质内均出现异常信号 ,仅 1例T2 WI未见异常信号 ,增强扫描 9例全部出现静脉异常强化。有 5例MRA除可见动脉正常显影外 ,还可见受累的静脉和静脉窦显影。MRV示栓塞的静脉窦不显影或显影欠佳。结论 :常规MRI结合MRA、MRV是诊断CVST的无创和有效手段     

Acute dural venous sinus thrombosis without brain parenchymal abnormality: assessment with cerebral blood volume using dynamic susceptibility contrast magnetic resonance imaging

We report results applying the dynamic susceptibility contrast (DSC) magnetic resonance (MR) technique to a patient with dural venous sinus thrombosis (DVST) of the right transverse-sigmoid sinus without brain parenchymal abnormality. The DSC-MR technique clearly demonstrated increased regional cerebral blood volume of the right temporo-parieto-occipital region adjacent to a right transverse-sigmoid sinus thrombosis in a patient with DVST without cerebral edema or hemorrhage.     

硬脑膜动静脉瘘MRI的诊断价值

目的探讨MRI、磁共振血管成像（MRA）在硬脑膜动静脉瘘的诊断及治疗评估中的作用。资料与方法回顾性分析14例硬脑膜动静脉瘘的临床资料及影像表现。所有患者术前均行头颅MRI、MRA及数字减影血管造影（DSA）,其中8例治疗后行MRI及MRA复查,对比分析患者MRI及MRA影像表现。结果MRI、MRA均能明确显示出增粗的供血动脉及扩张的引流静脉;同时显示脑出血（3例）,脑血栓（1例）,脑水肿（2例）,脑组织萎缩（1例）及栓塞物（治疗所置）（2例）等;8例经治疗后复查,MRI示7例扩张血管消失或缩小。结论MRI、MRA在硬脑膜动静脉瘘的诊断和术后评估中起着重要的作用。     

CT and high-field MRI in septic thrombosis of the cavernous sinuses

Summary In a patient with septic thrombosis of the cavernous sinuses CT demonstrated multiple filling defects due to clot formation, but 1.5 T MRI showed an atypical appearance of the thrombus, possibly because of the sepsis.     

Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life

A 31 year old woman presented with the worst headache of her life and was diagnosed with cerebral venous sinus thrombosis (CVST) by routine unenhanced computed tomography (CT) scan, subsequently confirmed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Awareness of this less common cause for acute neurological presentation in the Emergency setting is important; the imaging characteristics of CVST are reviewed.     

Dural enhancement with primary calvarial lesions

The purpose of this study was to relate the pathological and imaging features of dural enhancement and meningeal sign (dural tail) on contrast-enhanced T1-weighted magnetic resonance (MR) images from patients with primary calvarial lesions as well to assess the accuracy of MR imaging in predicting dural invasion. Thirty-two calvarial tumors studied with contrast-enhanced MR imaging and histopathological examination of the dural specimens were reviewed. Sixteen patients presented dural enhancement, eight with tumor invasion. Tumoral invasion of the dura was observed in one case without enhancement. Malignant lesions showed enhanced dura more commonly than benign lesions (P=0.02). Nodular and discontinuous dural enhancement was statistically associated with dural invasion (P=0.05). Dural tail did not show a specific pathological association. Meningeal enhancement is a nonspecific reaction to calvarial lesions unless nodular and discontinuous. False-negative and -positive cases of dural invasion imply some limitation of contrast-enhanced MR imaging in predicting dural invasion by calvarial neoplasms.     

硬脑膜窦血栓形成磁共振成像诊断

目的　总结硬脑膜窦血栓形成 (DST)头颅MRI及MRV表现特点。方法　回顾分析 2 0例DST患者的MRI及MRV表现。结果　MRI典型表现为硬脑膜窦内正常流空效应消失 ,代之以异常等信号或高信号影。病变好发部位依次为横窦 -乙状窦、上矢状窦、直窦 ,部分患者伴有皮质引流静脉及脑深部大静脉受累。MRV示受累静脉窦全程或节段性闭塞 ,病变部位和范围与MRI所见基本一致。结论　MRI及MRV可直接识别血栓 ,是目前无创性诊断DST的最可靠方法。     

MR血管成像在诊断下肢深静脉血栓形成中的价值并与DSA对照研究

目的探讨下肢深静脉血栓形成MR血管成像（MRA）的临床价值。方法对30例怀疑下肢深静脉血栓形成的患者进行了MRA和DSA检查，MRA采用二维时间飞越法（2DTOF）。对MRA与DSA表现进行对照分析。结果下肢深静脉血栓形成的MRA表现有1静脉充盈缺损（14例）、静脉闭塞和中断（8例）、静脉再通（3例）、侧支循环形成（25例）。以DSA为标准，MRA诊断出所有病变，但有1例假阳性。结论MRA作为无创性检查，是诊断下肢深静脉血栓有效的检查方法之一。     

颅内静脉窦血栓形成的影像学研究进展

颅内静脉窦血栓形成（CVST）是以脑静脉回流障碍为核心的特殊类型脑血管疾病,因该疾病临床表现多样且缺乏特异性,故临床早期诊断较为困难。患者若不能在早期得到诊断与治疗,轻者表现为头痛,严重者可引起瘫痪甚至死亡。综合的影像学检查对该病的诊断具有重要价值,有利于该病的早期诊断。笔者就该疾病的影像学研究进展予以综述。