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.

MRI Manifestation and Analysis of Misdiagnosis of Cerebral Venous Sinus Thrombosis

Objective To summarize MRI presentation of venous sinus thrombosis and analyze causes of misdiagnosis. Materials and Methods 32 patients with venous sinus thrombosis were analyzed retrospectively. 32 patients were examined by MRI, 17 of them by MRV, 12 of them by contrast-enhanced MRI and 29 by CT. All of the cases were confirmed by DSA. Results 26 of 32 cases were diagnosed correctly by MRI SE, including 20 cases with subaeute phase, 4 eases with acute phase and 2 eases with chronic phase. 6 cases with acute phase were misdiagnosed by plain MR, 4 of which were confirmed by MRV and 2 of which were confirmed by DSA. In acute phase, the signal intensity of venous sinus thrombosis were very complicated, which were shown as hypo, iso of slightly hyperintensity on T1WI, but obviously hypointensity on T2WI. In subaeute phase, they typically were demonstrated hyperintensity on T1WI and T2WI. Signal intensity gradually became lower in chronic phase. Venous sinus thrombosis were shown as occlusion and filling defects on MRV. 7 of 32 cases were ever misdiagnosed as tumors, cerebral infarct and other diseases. Conclusion MRI and MRV are good imaging modalities in the diagnosis of venous sinus thrombosis, which provide more meaningful information. Misdiagnosis can be avoided after analyzing MR presentation carefully and applying appropriate MR techniques.