脑静脉及静脉窦血栓的MR征象分析

目的 总结脑静脉及静脉窦血栓形成(CVST)的MRI及MRV成像特点,提高对其影像诊断水平.资料与方法 回顾分析39例经DSA或临床随访证实的CVST患者的临床及影像资料.结果 所有病例均行MRI平扫,19例行增强扫描,26例行MR静脉成像(MRV).MRI平扫表现为静脉窦流卒信号消失(38/39),血栓信号随病程长短而不同,急性期(11/38),血栓于T2WI多呈低信号(7/11),T1WI呈等信号(6/11)或略高信号(5/11);亚急性期(17/38),T2WI多呈高信号(12/17)、T1WI也多呈高信号(14/17);慢性期(10/38),T2WI多呈高信号(8/10),T1WI多呈等信号(6/10).增强扫描急性及亚急性期血栓均表现为受累静脉窦充盈缺损,慢性期多表现为血栓明显不均匀强化(6/7),静脉窦壁增厚毛糙.67%(26/39)病例出现闭塞静脉窦相应引流区域脑组织肿胀甚至出血,增强扫描肿胀区可出现异常强化(8/17),脑膜亦可强化(6/17);同时在闭塞静脉窦引流区可见多发强化血管信号(12/17).23例26人次MRV均可显示闭塞静脉窦血流信号缺失,其中2例治疗后静脉窦再通显示为不规则血流信号形成.结论 MRI结合MRV是CVST首选的无创检查方法,有助于CVST的早期诊断及排除诊断.     

颅内静脉血栓形成的磁共振诊断

目的:探讨磁共振成像(MRI)及磁共振静脉成像(MRV)对颅内静脉窦血栓形成(CVST)的诊断价值。方法:回顾性分析经临床和影像学方法确诊的14例CVST患者。MR检查技术包括平扫,增强扫描及MRV,14例均行CT平扫,其中1例行DSA检查。结果:14例CVST累及上矢状窦血栓形成4例,横窦血栓形成6例、乙状窦5例,MRI可清晰显示颅内静脉窦血栓形成的直接征象和间接征象,MRV可显示受累静脉窦不显影或者充盈缺损形成。结论:常规MRI结合MRV对颅内静脉窦血栓形成的早期诊断具有重要价值。     

脑静脉窦血栓形成的磁共振诊断

目的:探讨常规磁共振成像(MRI)及磁共振静脉成像(MRV)对脑静脉窦血栓形成(CVST)的诊断价值。方法:11例CVST患者,男3例,女8例,年龄19~56岁,平均39.4岁。使用Philps NT-5型0.5T超导磁共振扫描仪,常规行SE T1WI、TSE T2WI及液体衰减翻转恢复(FLAIR)序列检查,其中7例行相位对比(PC)法2D静脉血管成像。结果:MRI可清晰显示脑静脉窦血栓形成的直接征象(静脉窦流空效应消失,静脉窦内出现各期信号不同的血栓)和间接征象(脑水肿、脑梗死、脑出血等),MRV可更好地显示阻塞静脉窦。结论:常规MRI结合MRV对脑静脉窦血栓形成有较好的诊断价值。     

MRI在儿童静脉窦栓塞诊断中的价值

目的 评价MRI对儿童脑静脉窦血栓(CVST)的临床诊断价值.方法 回顾性分析15例(男11例,女4例,年龄10天～11岁,平均3.9岁)经临床确诊为CVST患儿的MRI及MRV表现.对所有病例均行MRI及MRV平扫,其中1例行增强MRI(CE-MRI)和增强MRV(CE-MRV)扫描. 结果 14例横窦受累,12例上矢状窦受累,11例乙状窦受累,1例蝶顶窦受累.MR平扫6例表现为T1WI等高信号、T2WI高信号;3例表现为T1WI等高信号、T2WI低信号;3例表现为T1WI、T2WI等信号;1例T1WI高信号、T2WI等信号;2例T1WI和T2WI血栓显示不明显.增强扫描表现为脑静脉异常强化,静脉窦壁表现为环形、三角形或平行状强化,而静脉窦内血栓无强化,呈不规则充盈缺损或空三角征.MRV表现为受累静脉窦显影不规则、狭窄或中断、侧支血管形成,邻近深静脉及浅静脉迂曲扩张.结论 MRI结合MRV,特别是增强MRI和MRV是诊断儿童CVST的有效手段,对于临床及时诊断治疗及随访具有重要价值.     

脑静脉窦血栓形成的磁共振成像诊断

目的　探讨磁共振成像 (MRI)和磁共振血管成像 (MRA)对脑静脉窦血栓形成的诊断价值。方法　 2 0例脑静脉窦血栓形成中 ,男 8例 ,女 12例。年龄 9～ 5 4岁 ,平均 3 5岁。全部有MRISE序列平扫 ,10例有TOF法静脉MRA ,3例有MRIGd -DTPA增强 ;13例有平扫CT对照。急性期 ( <1周 )脑静脉窦血栓形成 3例 ;亚急性期 ( 1～ 2周 ) 13例 ;慢性期 ( >2周 ) 4例。结果　 2 0例脑静脉窦血栓形成中 ,MRISE序列扫描确诊 19例 ,1例急性期早期MRI平扫漏诊 ,后经MRA确定。 13例CT平扫均未能确定脑静脉窦血栓的诊断。急性期脑静脉窦血栓MRI信号复杂 ,T1WI呈低、中等或稍高信号 ,T2 WI呈明显低信号。亚急性期呈短T1和长T2 信号 ,表现典型 ;慢性期由高信号到低信号 ,最后血栓吸收 ,静脉窦再通。MRA表现为静脉窦闭塞或静脉窦内充盈缺损。结论　MRI和MRA是诊断和随诊静脉窦血栓形成的有效手段 ,对脑静脉窦血栓的诊断优于CT ,可替代有创伤性的DSA检查     

磁共振不同序列成像在诊断脑静脉窦血栓形成中的应用

目的 探讨磁共振静脉成像序列(MRV)在诊断静脉窦血栓(CVST)中的应用价值.方法 研究收集2011年3月-2016年9月就诊并经影像科和神经内科明确诊断为脑静脉血栓的25例患者,其中所有受试者均行MRI平扫,17例同时行MRV检查,结合临床资料,对比影像资料,通过观察静脉窦血栓在MRI不同序列上的影像表现、阳性诊断率等指标,比较MRV序列在CVST诊断中的应用价值.结果 收集25例CVST患者病因复杂,临床表现无特异性,但早期出现头痛变现患者14例(56%). 17例做了MRI平扫同时也做了MRV的CVST患者中,其MRI平扫主要表现为:11例患者表现为患侧静脉窦血流的流空效应消失,17例患者的单或双侧额、顶、颞叶皮层及皮层下、小脑半球、丘脑以及基底节区可见散在、多发的小片状长T1、长T2信号影,边界不清.结论 CVST病因复杂,大部分患者早期可出现头痛症状,但无特异性,对于临床诊断无明确指导意义.MRV序列可显著提高CVST的阳性检出率,值得在临床工作中推广.     

颅内静脉窦血栓形成的影像学诊断

目的 探讨颅内静脉窦血栓形成的影像学诊断.方法 回顾性分析15例经临床和影像检查确诊的静脉窦血栓患者中,行CT检查11例,MRI+ MRV检查15例,DSA检查8例.结果 CVST直接征象12例,即血栓本身征象:急性和亚急性期CT平扫静脉窦区可见三角形或条索样高密度灶,慢性期为低密度灶;MRI平扫,正常静脉窦流空信号消失,其内见不同时期血栓信号.CT和MRI增强扫描见静脉窦内三角形或条索样充盈缺损.MRV和DSA可见静脉窦内充盈缺损或静脉窦不显影.间接征象6例,表现为脑实质内水肿、静脉性脑梗塞及不典型部位脑出血、脑静脉扩张.其中3例同时可见直接征象和间接征象.结论 综合影像学检查可以明确诊断颅内静脉窦血栓形成,DSA检查是诊断静脉窦血栓的金标准.     

脑静脉窦血栓的磁共振表现及误漏诊分析

目的总结脑静脉窦血栓（CVST）的磁共振表现,并进行误漏诊分析. 资料与方法回顾性分析32例脑静脉窦血栓的磁共振表现.全部病例均进行MRI检查,其中17例同时行磁共振静脉成像（MRV）检查,12例行增强扫描,29例行CT检查.全部病例经DSA证实. 结果 32例CVST患者中,MRI SE序列扫描确诊26例,其中亚急性期病变20例,急性期4例,慢性期2例.6例急性期病变MRI平扫漏诊,其中4例经MRV确诊,2例经DSA诊断.急性期CVST MRI信号复杂,T1WI呈低、中等或稍高信号,T2WI呈明显低信号.亚急性期T1WI和T2WI均呈高信号,表现典型;慢性期血栓信号不断地降低.MRV表现为静脉窦闭塞或静脉窦内充盈缺损.本组病例中有7例曾被误诊为肿瘤、脑梗死等其他病变. 结论 MRI和MRV是诊断CVST的良好检查方法,可提供更多可靠信息.应用适当的检查技术,以及对MR征象进行认真分析,可避免误诊及漏诊.     

MR增强FLAIR和T_1WI序列对儿童感染性脑膜炎成像效能的对比

目的：分析儿童感染性脑膜炎的MRI特征,并对增强FLAIR和T1WI序列的成像效能进行评价,探讨增强FLAIR序列对儿童感染性脑膜炎的诊断价值。方法：感染性脑膜炎患儿15例,均行常规MRI平扫及增强检查,增强检查包括T1WI及FLAIR扫描。图像由3位有经验的影像诊断医师进行评估。结果：增强FLAIR序列对感染性脑膜炎病变的显示较敏感,同时可以将强化的皮层静脉及静脉窦正确区分,并可显示脑脊液的强化,但对于伴有脑实质内微小病灶的显示具有一定的局限性。结论：增强FLAIR和增强T1WI结合可以获得更全面的信息,增强FLAIR可作为增强T1WI的有益补充。     

颅内静脉窦血栓形成的CT、MRI诊断

目的 探讨颅内静脉窦血栓形成的CT、MRI诊断价值.方法 收集12例经临床随访证实的颅内静脉窦血栓形成的病例,分析其影像学表现.结果 CT平扫发现静脉窦区高密度影,MRI平扫见正常的静脉窦流空信号消失,增强MRI见空三角征,3D CE-MRV显示静脉窦内稍高信号充盈缺损影.结论 MRI、CE-MRI、3D CE-MRV联合运用可以提高脑静脉窦血栓形成的诊断准确率,CT扫描用于静脉窦血栓形成的初筛及并发症的检查.     

磁共振脑静脉系血管成像技术及其临床应用

目的探讨磁共振脑静脉系血管成像的技术方法和最佳扫描方案，评价磁共振静脉系血管成像技术(MR venography，MRV)对静脉系疾病的诊断价值及临床意义。方法采用二维时间飞跃法MR血管造影(2D-TOF-MRA)、二维相位对比血管造影(2D-PCA)和三维对比增强MR血管造影(3D-CE-MRA)3种血管成像技术分别对20例健康志愿者和20例临床或MRI疑有静脉系疾病的患者行MRV成像，并采用最大强度投影(MIP)、多平面或曲面重建(MPR)及数字减影MRA(DSMRA)技术对图像进行后处理，观察脑静脉系在MRV中的显示情况及脑静脉系疾病在MRV中表现形式，制定脑静脉系成像的最佳方案。结果本组经3D-CE-MRA静脉系成像诊断为13例颅内静脉窦血栓形成(CVST)及7例颅内肿瘤累及静脉系的阳性显示率为100％，均经临床治疗复诊及手术证实。2D-PCA及2D-TOF-MRA对细小引流静脉显示欠佳，且2D-TOF-MRA对复杂区域内静脉血管亦显示欠佳。结论3D-CE-MRA结合2D-PCA及2D-TOF-MRA静脉成像技术形成全脑静脉系成像，为脑静脉系的最佳成像方案，对临床术前评估和指导治疗有极其重要的意义。     

脑静脉及静脉窦血栓21例CT磁共振表现及漏误诊分析

目的总结颅内静脉与静脉窦血栓形成(CVST)的CT及磁共振(MR)表现,分析漏误诊的原因。方法回顾性分析21例CVST病例的CT和MR影像,全部病例均有MR资料,12例有低场强磁共振脑静脉窦血管成像(MRV)资料,15例有CT资料。结果 CVST的CT表现为病变静脉窦的高密度影、束带征及Delta征;MR主要表现为病变静脉窦内短T1长T2信号;MRV表现为血栓形成静脉窦的闭塞;本组21例CVST,影像科初诊漏诊2例,误诊5例。结论正确认识CVST的束带征、急性早期征象及静脉性脑梗死的改变,能减少漏误诊的发生。     

Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence: prospective comparison with 2D-TOF MR venography and digital subtraction angiography

BACKGROUND AND PURPOSE: The diagnosis of dural sinus thrombosis is often difficult because of its variable and nonspecific clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. We compared 3D contrast-enhanced magnetization-prepared rapid gradient-echo (MP-RAGE) sequences with 2D time-of-flight (TOF) MR venography, digital subtraction angiography (DSA), and conventional spin-echo (SE) MR imaging for the assessment of normal and abnormal dural sinuses. METHODS: In a phantom study, a plastic tube with pulsating flow was used to simulate the intracranial dural sinus. With 3D MP-RAGE, a variety of flow velocities, contrast material concentrations, and angulations between the phantom flow tube and the plane of acquisition were tested to measure their relationship to signal-to-noise ratio (SNR). In a clinical study, 35 patients, including 18 with suspected dural sinus thrombosis, were studied with both MR imaging and DSA. Receiver operating characteristic (ROC) analysis was performed in a blinded fashion using DSA as the reference standard. RESULTS: With the phantom, the SNR of flow increased with increasing contrast concentration, but was not affected by the angle between the tube and scan slab. There was no relationship between SNR and velocity when the contrast concentration was 1.0 mmol/L or greater. In the clinical study, dural sinus thrombosis as well as the normal anatomy of the dural sinuses were seen better with 3D contrast-enhanced MP-RAGE than with 2D-TOF MR venography. Three-dimensional contrast-enhanced MP-RAGE showed the highest diagnostic confidence on ROC curves in the diagnosis of thrombosis. CONCLUSION: Three-dimensional contrast-enhanced MP-RAGE is superior to 2D-TOF MR venography and conventional SE MR imaging in the depiction of normal venous structures and the diagnosis of dural sinus thrombosis, and is a potential alternative to DSA.     

Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses

BACKGROUND AND PURPOSE: The diagnosis of cerebral venous and sinus thrombosis (CVST) as a rare but important cause of stroke is challenging. We aimed to investigate the diagnostic value of multidetector-row CT angiography (MDCTA) as a fast and cost-effective imaging tool in diagnosing CVST. MATERIALS AND METHODS: Nineteen patients who presented with clinical symptoms of a possible CVST were included. All patients had received both MDCTA and MR imaging with venous MR-angiography. Three blinded readers were asked to identify the cerebral sinuses and veins in MDCTA and to evaluate the presence of CVST in MDCTA. Consensus reading with interpretation of the MR imaging served to establish the definite diagnosis. RESULTS: The consensus reading revealed CVST in 10 of the 19 patients. With MDCTA, the venous sinuses could be identified in 99.2% and the cerebral veins in 87.6% of cases. The sensitivity and specificity of MDCTA for the diagnosis of CVST were 100%. CONCLUSION: Our study demonstrates that MDCTA provides excellent sensitivity and specificity for the diagnosis of CVST. Further studies are needed to evaluate the diagnostic potential of MDCTA in specific subsets of the general entity of CVST such as cortical venous thrombosis, thrombosis of the cavernous sinus, and thrombosis of the internal cerebral veins.     

Utility of contrast-enhanced 3D turbo-flash MR angiography in evaluating the intracranial venous system

The objective of this study was to compare the effectiveness of contrast-enhanced 3D turbo-flash and 2D time-of-flight (TOF) magnetic resonance angiography (MRA) sequences in the visualization and evaluation of the intracranial venous system. A prospective study was carried out on 41 patients referred to our Magnetic Resonance Imaging (MRI) unit with clinical findings suggestive of dural sinus thrombosis. Contrast-enhanced 3D turbo-flash and 2D TOF MRA sequences were performed, and the dural sinuses and cerebral veins were classified into five grades according to the quality of visualization and presence of thrombosis. We found the dural sinuses and cerebral veins to be normal in all sequences in 31 patients. Thrombosis of dural sinuses was detected in ten patients, with four of these ten cases found only in the contrast-enhanced 3D turbo-flash sequence. In general, complete visualization of cerebral veins and dural sinuses was significantly better accomplished with contrast-enhanced 3D turbo-flash MRA than with 2D TOF in either coronal or sagittal/oblique planes. Although 2D TOF MRA may be superior in detecting chronic dural sinus thrombosis, contrast-enhanced 3D turbo-flash MRA sequences may offer advantages for the early diagnosis and management of acute and subacute dural sinus thrombosis.     

The value of T2*-weighted gradient-echo MRI for the diagnosis of cerebral venous sinus thrombosis

ObjectivesThe purpose of this study is to compare the various magnetic resonance imaging (MRI) sequences when they are used to visualize and evaluate cerebral venous thrombosis.MethodsEleven patients with cerebral venous thrombosis were retrospectively analyzed using computed tomography, MRI, magnetic resonance angiography (MRA), and conventional angiography. The MR sequence included T1-weighted spin echo (SE) imaging, obtained before and after administration of contrast medium, T2-weighted turbo spin echo (TSE), fluid-attenuated inversion recovery (FLAIR), T2*-weighted conventional gradient-echo (GRE), as well as three-dimensional (3D) venous time-of-flight MRA and conventional angiography.ResultsIn all of our patients, the venous sinus thromboses were most successfully detected during the T2*-weighted GRE sequence. The thrombosis was well visualized with the T1-weighted SE sequence in three of four patients in whom it was in the subacute stage. The T2*-weighted GRE sequence was superior to the T2-weighted TSE, T1-weighted SE, and FLAIR sequences in all patients. Enhanced 3D MR venography showed the thrombosed segment of the venous sinus and well correlated with the conventional angiographic findings.ConclusionsThe T2*-weighted conventional GRE sequences may be the best method for detecting of cerebral venous thrombosis. Therefore, it would seem to be beneficial to integrate a T2*-weighted conventional GRE sequence into the MR protocol to diagnose cerebral venous thrombosis.     

颅内静脉窦血栓形成的早期MRI诊断及病理基础

目的:研究颅内静脉窦血栓形成(CVST)的MR表现及其病理基础,旨在提高早期诊断水平.方法:回顾分析经临床和影像学方法确诊的11例CVST患者.MR检查技术包括平扫、增强扫描及MRV;其中4例行CT平扫检查;3例行DSA检查.结果:11例CVST累及上矢状窦5例,横窦1例,乙状窦1例,直窦1例,上矢状窦及横窦及乙状窦联合受累2例,横窦及乙状窦联合受累1例.CVST的直接征象:急性期血栓3例,T1 WI呈等信号或等高混杂信号,T2 WI呈低信号,周围可见稍高信号的环,为增厚的硬膜;亚急性期血栓8例,T1 WI及T2 WI均以高信号为主.增强扫描受累静脉窦可见空"三角"征或"充盈缺损"征.MRV可显示受累静脉窦不显影或者充盈缺损形成.CVST的继发脑损害包括脑肿胀、出血及梗死等.结论:磁共振检查对CVST的早期诊断具有重要价值.对于T2 WI呈低信号的急性期血栓,应仔细观察围是否有较高信号的环形改变,进一步行增强扫描结合MRV检查可作出早期准确的诊断.     

三维增强磁共振静脉成像评价颅内静脉系统

目的:比较三维增强FLASH序列和2D TOF序列MR静脉成像(MRV)对颅内静脉系统的诊断价值.方法:本组11例中健康志愿者6例(正常组),脑静脉窦血栓形成患者5例(病变组),均同时行3D增强FLASH和2D TOF序列MRV扫描,病变组5例患者同时行DSA检查.将脑内主要静脉(14支)的显示情况分为3级:满意显示,一般显示和未显示.比较两种扫描方法对脑内静脉和静脉血栓的显示情况.结果:正常组中三维增强FLASH和2D TOF序列对所观察的14支脑静脉的满意显示率、一般显示率和未显示率分别为88.10%,5.95%,5.95%和30.95%,53.57%,15.48%.三维增强FLASH未显示结构主要为下矢状窦.病变组5例中DSA共发现12处血管病变,三维增强FLASH显示优于2D TOF 10处,两者相仿2处.结论:三维增强FLASH对脑静脉系统的显示优于2D TOF序列,可以提供高质量的脑内静脉结构的图像,对诊断脑静脉内血栓形成有重要临床价值.     

MRI联合磁共振静脉成像诊断脑静脉窦血栓形成的价值

目的:探讨MRI及磁共振静脉成像(MRV)对脑静脉窦血栓形成的诊断价值.方法:回顾性分析37例DSA确诊脑静脉窦血栓形成患者的临床资料及影像表现.37例中有30例行常规MRI检查,29例行MRV(2D TOF)检查.结果:30例常规MRI检查中28例静脉窦有异常信号,其中26例MRI表现为静脉窦T1WI、T2WI高信号,2例T1WI等信号、T2WI低信号,并部分伴有脑组织梗死、出血.29例MRV检查均发现静脉窦充盈缺损或中断.结论:MRI与MRV结合对诊断脑静脉窦血栓形成具有高度敏感性,是诊断静脉窦血栓形成的首选检查方法.