Sinus pericranii

Sinus pericranii is a rare anomaly that occurs when there is communication between the intracranial and extracranial venous systems. Accurate diagnosis is complicated because several other cranial masses can mimic sinus pericranii. Clinical, laboratory, and imaging assessments are all essential for identifying the anomaly. This article examines the comparative advantages of various diagnostic imaging modalities, current imaging techniques, and typical findings associated with sinus pericranii. Treatment and management options also are discussed.     

CTV对脑静脉窦血栓诊断价值的研究

目的探讨CTV对脑静脉窦血栓的诊断价值。方法回顾性分析40例脑静脉窦血栓患者的CTV表现。结果 40例CT平扫中条索征及高密度三角征27例,静脉性出血性脑梗死14例,静脉引流区脑水肿10例。40例CTV中空三角征及静脉窦充盈缺损35例,大脑镰和\或小脑幕异常强化23例,脑穿通髓静脉扩张16例,脑室扩大或缩小18例,不强化的脑白质低密度区18例。结论 CTV对脑静脉窦血栓的诊断具有较高的应用价值,完全能满足临床的早期诊断要求。     

儿童颅骨膜血窦的影像学诊断

目的探讨儿童颅骨膜血窦的影像学表现，以提高对本病的认识。资料与方法回顾性分析8例儿童颅骨膜血窦的临床资料和CT、MRI表现。结果颅骨膜血窦的特征性临床症状为随颅内压改变而变化的头皮肿块。病变位于颅顶部4例，额部2例，颞部1例，枕部1例。CT表现为颅板外头皮下软组织肿块，增强后呈明显均匀强化。骨窗及三维成像可显示颅骨的孔状缺损。MRI表现为头皮下肿块，T1WI为等信号，T2WI为高信号。并清晰显示异常连接静脉。结论儿童颅骨膜血窦具有典型的CT、MRI表现，结合患者特征性临床表现，对该病能作出明确诊断。     

脑静脉窦和静脉血栓形成的影像学诊断与分析

目的 探讨脑静脉窦和静脉血栓形成(CVST)的影像特征及诊断体会.方法 回顾性分析28例CVST患者的影像学表现、影像诊断特征.结果 (1)CVST的CT及MRI影像学表现只有少数病例可见典型的"条索状"直接征象(3.57%);最常见的间接征象为非典型性的脑出血(50.00%)及脑梗死(CT:32.14%,MRI:39.29%),发病部位以双侧性较多(75.00%).(2)大部分CVST患者的磁共振静脉成像(MRV)或CT静脉血管成像(CTV)出现静脉窦连续性中断,充盈缺损区,完全性或虫蚀状改变等直接征象(CTV:100%,MRV:83.33%),还可出现远端静脉窦增粗及引流静脉扩张等间接征象.结论 CVST的CT及MRI常规影像学表现无明显特异性,而CTV和MRV影像学表现具有较高的特异性,若怀疑CVST应尽早行MRV或CTV检查以明确诊断.     

脑静脉窦和静脉血栓形成的影像学诊断与分析

目的 探讨脑静脉窦和静脉血栓形成(CVST)的影像特征及诊断体会.方法 回顾性分析28例CVST患者的影像学表现、影像诊断特征.结果 (1)CVST的CT及MRI影像学表现只有少数病例可见典型的"条索状"直接征象(3.57%);最常见的间接征象为非典型性的脑出血(50.00%)及脑梗死(CT:32.14%,MRI:39.29%),发病部位以双侧性较多(75.00%).(2)大部分CVST患者的磁共振静脉成像(MRV)或CT静脉血管成像(CTV)出现静脉窦连续性中断,充盈缺损区,完全性或虫蚀状改变等直接征象(CTV:100%,MRV:83.33%),还可出现远端静脉窦增粗及引流静脉扩张等间接征象.结论 CVST的CT及MRI常规影像学表现无明显特异性,而CTV和MRV影像学表现具有较高的特异性,若怀疑CVST应尽早行MRV或CTV检查以明确诊断.     

Usefulness of MR venography in diagnosing sinus pericranii: case report

A case of sinus pericranii communicating with the superior sagittal sinus is reported. Computed tomography (CT), magnetic resonance (MR) imaging, and angiography showed characteristic findings of sinus pericranii. However, MR venography was useful to visualize the entire lesion.     

双源CT静脉造影对上矢状窦旁脑膜瘤显微手术的价值探讨

目的 探讨脑双源CT静脉造影(CTV)显示上矢状窦旁脑膜瘤与上矢状窦关系、显示中央沟静脉和代偿回流静脉情况,从而为神经外科制定手术方案提供重要信息.方法 32例上矢状窦旁脑膜瘤患者行脑CTV检查,在工作站重建三维图像,术前判断肿瘤与静脉窦关系、显示中央沟静脉和代偿回流静脉并与术中情况对照.结果 根据CTV显示的窦腔狭窄程度,将上矢状窦旁脑膜瘤分为三型:Ⅰ型,瘤体与一侧静脉窦壁外层附着,静脉窦壁正常或轻度受压,窦腔通畅;Ⅱ型,肿瘤沿静脉窦壁生长,窦壁不规则增厚,窦腔变窄但尚通畅;Ⅲ型,瘤体长人静脉窦内或跨越生长,静脉窦腔内形成充盈缺损,窦腔闭塞,同时有静脉侧支循环建立.本组Ⅰ型8例,Ⅱ型15例,Ⅲ型9例.术中观察到代偿扩张的浅静脉以及肿瘤与中央沟静脉、上矢状窦的关系均与CTV结果相符.本组无术后严重神经功能受损和死亡病例.结论 上矢状窦旁脑膜瘤患者术前行CTV检查可以明确肿瘤部位、矢状窦阻塞程度及引流静脉代偿情况,为手术人路的选择及手术方案的制定提供重要信息,在全切肿瘤的同时减少并发症的发生,提高患者的生活质量.     

CT血管造影在颅内静脉畸形诊断中的应用

目的 评价CT血管造影在诊断颅内静脉畸形中的价值与限度。材料与方法 5例经DSA证实的颅内静脉畸形病例,幕上1例,幕下4例。分别在动脉期（CTA）和静脉期（CTV）扫描采样,运用SSD和MIP进行重建。结果 CTA显示所有病灶,但没有显示颅内静脉畸形的“海蛇头”即引流静脉影像特征,而CTV不仅显示病灶,而且还显示了引流静脉“海蛇头”影像特征。结论 静脉期的CT血管造影（CTV）是诊断和随访颅内静脉畸形的有效方法,优于动脉期的CT血管造影（CTA）。     

Computed tomography pulmonary angiography with pelvic venography in the evaluation of thrombo-embolic disease

A prospective study was performed to evaluate the usefulness of CT pelvic venography (CTV) in the detection of pelvic vein thrombosis in patients referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism. Fifty consecutive patients referred for CTPA had CTV performed at the time of CTPA. All patients had duplex ultrasound (DUS) of the lower limb veins for evaluation of deep venous thrombosis (DVT) within 24 h of the CT study. Twelve (24%) of the 50 patients had pulmonary embolism diagnosed on CTPA. Associated DVT was detected in six of these patients; two cases were detected by CTV alone, while one case was detected by both CTV and DUS. The remaining three cases had DVT diagnosed by DUS alone. In the 38 patients with a negative CTPA, three patients had venous thrombus diagnosed by CTV. Of these three patients, two had a negative DUS study. CTV therefore led to a definitive imaging diagnosis of thrombo-embolic disease in two (4%) more patients. CTV adds little time and cost to the CTPA examination and leads to a moderate increase in definite imaging diagnosis of thrombo-embolic disease.     

Preoperative evaluation of venous systems with computed tomography venography in parasagittal meningiomas

OBJECTIVE: Parasagittal meningiomas (PSM) may pose a difficult surgical challenge because venous patency and collateral anastomoses have to be clearly defined for correct surgical planning. The aim of this study was to study the diagnostic accuracy of computed tomography venography (CTV) in assessing the superior sagittal sinus (SSS) obstruction and venous collaterals. METHODS: Twenty-four patients undergoing surgery for meningiomas located adjacent to the SSS were prospectively evaluated. All the patients underwent both conventional computed tomography examination and CTV. Computed tomography venography was evaluated by 2 expert neuroradiologists to assess (1) patency of the sinus (patent/occluded), (2) the extent of occlusion (in centimeters), and (3) the number of collateral anastomoses close to the insertion of the meningioma. Computed tomography venography assessment was compared with surgery. All patients were operated on, and intraoperative findings were taken as the criterion standard. RESULTS: Computed tomography venography showed the sinus to be occluded in 6 cases. Computed tomography venography data were confirmed by surgery, showing 6 patients to have have an occlusion of the SSS. The CTV sensitivity was thus 100%. Computed tomography venography depicted 83% of collateral venous anastomoses close to the meningioma as subsequently confirmed by surgery. CONCLUSIONS: In the preoperative planning for patients with meningiomas located close to the SSS, CTV can provide additional and more reliable information concerning venous infiltration and the presence of collateral anastomoses compared with noncontrast computed tomography.     

2D time-of-flight MR venography in neonates: anatomy and pitfalls

BACKGROUND AND PURPOSE: The dural venous sinuses in neonates differ from those in adults or older children in that the caliber of venous sinuses is smaller and there is skull molding. The aim of this retrospective study is to evaluate the presence of flow gaps in venous sinuses in neonates on 2D time-of-flight (TOF) MR venography (MRV). METHODS: Fifty-one neonates underwent coronal 2D TOF MRV. Nine also had CT venography (CTV) for comparison. In 1 neonate, a further 2D TOF MRV was performed in the sagittal plane; in another neonate, images were captured in the axial plane; and in another, a further coronal TOF MRV with shorter echo time was performed. RESULTS: Flow gap was seen in the posterior aspect of the superior sagittal sinus in 35 of 51 (69%). Focal narrowing of the superior sagittal sinus, in the region of convergence of lambdoid sutures, was detected in 7 of 51 (14%). The right and left transverse sinuses demonstrated flow gap in 13 of 51 (25%) and 32 of 51 (63%) respectively. There was normal filling of contrast on CTV in the superior sagittal sinus, transverse sinus and sigmoid sinus in those cases with flow gap detected on coronal 2D TOF MRV. Right, left, and codominance of the transverse sinuses are as follows: 32 of 51 (63%), 5 of 51 (10%), and 14 of 51 (27%), respectively. The right and left sigmoid sinuses demonstrated flow gap in 7 of 51 (14%) and 8 of 51 (16%), respectively, and the left sigmoid sinus was absent in 1 of 51 (2%). CONCLUSION: The high proportion of flow gap in the venous sinuses of neonates, particularly of the superior sagittal sinus, could be attributed to the smaller caliber venous sinuses, slower venous flow, and skull molding.     

64排螺旋CT静脉造影诊断下肢静脉血栓性病变

目的:探讨64排螺旋CT静脉造影(CTV)诊断下肢静脉血栓性病变的临床价值。材料和方法:下肢多层螺旋CT静脉造影(MSCTV)检查12例,同期均做下肢静脉Dopp ler超声(US)检查;其中1例同时进行了肺动脉CT血管造影,并于延迟2m in时行间接法下肢静脉造影检查。病例均采用5mm层厚和层间距行踝关节至髂骨上缘水平的增强CT扫描,并获得原始图像,图像经1.25mm层厚和50%的重叠处理后传送至工作站进行图像后处理。结果:64排螺旋CTV诊断下肢深静脉血栓(DVT)11例,诊断下肢慢性静脉功能不全1例,同时合并肺栓塞1例。以US作对照,64排螺旋CTV显示股静脉和腘静脉血栓的敏感性为100%,特异性98.6%。MSCTV上DVT表现为静脉腔内不规则低密度充盈缺损,慢性静脉功能不全表现为深静脉边缘不规则且于延迟2m in扫描见其远端引流静脉区造影剂点状残留。结论:64排螺旋CTV在显示股腘静脉血栓与US具有同等价值,MSCTV可作为下肢静脉血栓性病变诊断的常规检查方法。     

CT venography vs ultrasound in the diagnosis of thromboembolic disease in patients with clinical suspicion of pulmonary embolism

To assess the reliability of indirect computed tomography venography (CTV) in the detection of deep venous thrombosis (DVT) in patients with clinical suspicion of pulmonary embolism (PE). 235 consecutive patients with suspicion of PE underwent an imaging protocol composed of a CT pulmonary angiography (CTPA), a CTV and an ultrasound study of the deep venous system, which was considered the “gold standard.” Sensitivity, specificity, and predictive values were calculated for CTV. ith CTV, 30 (12.8%) cases of DVT were detected, 9 (3.8%) of them without pulmonary embolism in CTPA, increasing the diagnosis of thromboembolic disease in 3.8%. However, six of these nine diagnoses were false positives, and CTV missed six cases of DVT. CTV rendered a sensitivity of 58.8%, specificity of 95.0%, a positive predictive value of 66.7%, and a negative predictive value of 93.2%. In patients with clinical suspicion of pulmonary embolism, ultrasound is preferred to CTV for the detection of DVT.     

Sinus pericranii: CT and MR findings

A case of sinus pericranii communicating with the right transverse sinus is reported. The radiographic findings on CT, angiography, and magnetic resonance imaging are presented.     

Sinus pericranii: diagnostic and therapeutic considerations in 15 patients

INTRODUCTION: Sinus pericranii (SP) is a rare, usually asymptomatic condition characterized by a large communication between the intra- and the extracranial venous drainage pathways in which blood may circulate bidirectionally through dilated veins of the skull. We describe our diagnostic and therapeutic experience with SP, with a special focus on the vascular analysis of digital subtraction angiography (DSA). METHODS: DSA images of 15 patients were evaluated with regard to the delay in opacification of the scalp vessels, the absence or distortion of the superficial cortical veins in the vicinity of the SP, the drainage patterns of the superior sagittal sinus, and the degree of maturation of the venous outlets of the brain. SP were classified either as "dominant", if the main stream of contrast flow used the SP to drain the brain bypassing usual venous outlets, or as "accessory", if only a small part of the venous outflow occurred through the extradiploic vessels. RESULTS: All patients presented with a nonpulsatile, soft-tissue mass. The lesion was on the midline in 14 of 15 patients, frontal in 12 patients, and parietal in 2 patients. In 13 patients, associated intracranial venous anomalies were present, eight of which were developmental venous anomalies. Seven patients had a dominant SP, and eight an accessory SP. CONCLUSION: SP can be considered the cutaneous sign of an underlying venous anomaly. If treatment is contemplated, analysis of the drainage pattern of the SP has to be performed. Treatment should be avoided in dominant SP or if its accessory role constitutes the only collateral pathway of an underlying venous anomaly.     

CT和MR血管造影在颅内静脉畸形诊断中的应用

目的：评价CT、MR血管造影在诊断颅内静脉畸形中的价值与限度。材料和方法：5例经DSA证实的颅内静脉畸形病例,男2例,女3例,平均年龄37岁（10-66岁）,幕上1例,幕下4例。分别在动脉期（CTA）和静脉期（CTV）扫描采样,运用SSD和MIP进行重建,全部病例行MRA、MRV检查,4例做了增强前后MRV检查。结果：CTA显示所有病灶,但没有显示颅内静脉畸形的“海蛇头“,即引流静脉影像特征,而CTV不仅显示病灶,而且还显示了引流静脉“海蛇头“影像特征;MRV显示5例病灶和其特征性的“海蛇头“影像特征,MRA没有一例显示病灶的“海蛇头“表现,4例增强前后MRV没有明显差异。结论：MRV和静脉期的CT血管造影（CTV）是诊断和随访颅内静脉畸形的有效方法,优于动脉期的CT血管造影（CTA）,MRA可作筛选之用,排除其他血管性病变。     

Prospective comparison of indirect CT venography versus venous sonography in ICU patients

OBJECTIVE: The purpose of our study was to prospectively compare indirect CT venography (CTV) and duplex venous sonography in the evaluation of acute deep venous thrombosis (DVT) in ICU patients with suspected pulmonary embolism. SUBJECTS AND METHODS: All ICU patients undergoing CT pulmonary angiography in the evaluation of acute pulmonary embolism during a 10-month period were included in the study group. Indirect CTV was performed 3 min after initiation of the contrast bolus and was compared with duplex venous sonography of the lower extremities. Both techniques were compared with a clinical standard when DVT was considered present if a positive result was obtained on sonography or on CTV in the setting of pulmonary embolism. RESULTS: The study group comprised 61 ICU patients. Using the clinical standard, DVT was detected in 10 of 61 patients. The sensitivity and specificity for CTV were 70% and 96%, respectively, and for sonography were 70% and 100%. CONCLUSION: The performance characteristics of CTV and deep venous sonography were similar when compared with a clinical standard. The results support the use of indirect CTV after CT pulmonary angiography as an alternative to sonography in the ICU population.     

16层螺旋CT双期脑血管成像诊断脑静脉血管瘤的价值

目的：探讨16层螺旋CT双期脑血管成像对脑静脉血管瘤的临床诊断价值。方法：回顾性分析15例脑静脉血管瘤的16层螺旋CTA及CTV表现。结果：动脉期CT血管造影5例未发现明显异常，10例病灶仅部分显示，且密度淡。静脉期脑CT血管造影15例均清晰显示放射状排列的髓静脉及中央静脉，整个形态似海蛇头。结论：16层螺旋CT双期血管造影能清晰显示脑静脉血管瘤的影像特征，是诊断本病的可靠方法。     

Laterally situated sinus pericranii. Report of two cases with marked diploic veins

Summary sinus pericranii has been reported to be situated usually along the midline. Two cases of laterally situated sinus pericranii are presented. Venous blood was obtained by puncturing the tumors directly. Injection of contrast medium into the tumors demonstrated a communication between the tumors and the intracranialvenous sinuses through marked diploic veins.     

Benefit of CT venography for the diagnosis of thromboembolic disease

OBJECTIVE: The aim of this study was to determine the benefit of lower extremity CT venography (CTV) with pulmonary CT angiography (CTA) for diagnosing thromboembolic (TE) disease. SUBJECTS AND METHODS: Reports of all CTAs and CTVs over a 3-year interval (Group I) and CTAs, CTVs, and lower extremity Doppler ultrasounds (US) over a 1 1/2-year subset (Group II) were reviewed. Patient population was inpatients and emergency department patients who were assessed for pulmonary embolism (PE) and deep venous thrombosis (DVT) at a tertiary care hospital. Reported results for CTA or CTV were categorized as positive (CTA(P), CTV(P)), negative (CTA(N), CTV(N)), or indeterminate for PE or DVT. When CTV and US results were discrepant, medical records were reviewed for clinical management. Additional benefit of CTV was assessed by chi-square analysis. RESULTS: In Group I, 737 (81.1%) of 909 CTAs from combined CTA/CTV studies were negative. The diagnosis rate of TE disease increased from 13.0% to 17.3% with the addition of CTV(P)s (P=.01). Of the 119 cases in Group II undergoing combined CTA, CTV, and US, CTV and US were both positive in eight and both negative in 88. Of the seven discordant CTVs and USs with clinical follow-up, five CTVs were positive while USs were negative, three of which were treated clinically for TE disease, while two were considered falsely positive. As CTA also proved positive in one of the three, CTV therefore affected management in two of these five cases and increased the rate of thromboembolism diagnosis from 21.0% to 22.6%; however, this was not significant (P>.05). Two CTV(N)s were managed as false negatives. CONCLUSIONS: The combined use of CTA and CTV significantly increases the rate of TE disease over CTA alone. In cases in which ultrasound is performed, however, there is no significant advantage to performing combined CTA/CTV studies.