脑静脉血栓的临床特点及影像学表现分析

目的探讨脑静脉血栓(cerebral venous thrombosis,CVT)的临床资料特点、影像学特征及诊断特点。方法回顾性分析30例CVT患者的临床资料特点、影像学表现及诊断特点。结果 (1)30例患者的病因繁杂,分感染性和非感染性两类,感染性相关因素最为常见,占50%。其临床表现复杂且无特异性,主要及首要的症状为头痛。(2)30例CVT患者,经CT、MRI及MRV检查发现累及上矢状窦22例,下矢状窦1例,横窦22例,乙状窦18例,直窦5例,窦汇5例,海绵窦1例,深静脉1例,皮层静脉1例。(3)28例患者进行了CT检查,25例发现异常表现,16例出现索条征、高密度三角征;15例出现脑实质水肿、静脉性脑梗死及合并出血;30例患者均进行了MRI及MRV检查,其中29例MRI检查阳性,表现为CVT形成导致的流空效应的消失,并且出现各时期不同程度的血栓信号,漏诊的1例经MRV检查确诊;30例患者MRV检查均阳性,表现为脑静脉及静脉窦充盈缺损、信号缺失及侧支循环形成。结论CVT病因复杂,发病形式多种多样,临床表现没有特异性。CT、MRI及MRV检查是诊断CVT的无创、准确且敏感的神经影像学技术,其中MRI联合MRV诊断最重要。

Clinical and imaging features of cerebral venosinus thrombosis

Objective To investigate the clinical and imaging features of cerebral venosinus thrombosis (CVT). Methods The clinical and CT/MR imaging features of 30 patients with CVT were analyzed retrospectively. Results The clinical manifestation was complex and nonspecific with headache as the most common symptom. CT, MRI and MR venography (MRV) showed thrombosis of the superior sagittal sinus (22), transverse sinus (22), sigmoid sinus (18), straight sinus (5), torcula (5), inferior sagittal sinus (1), cavernous sinus (1), deep vein (1), and cortical veins (1). CT demonstrated abnormality in 25/28 patients with stripe and triangular high densities(16), brain edema (15), cerebral infarction and hemorrhage. MRI showed loss of flow void with thrombus of varying age in 29/30 cases. MRV showed filling defects, signal loss and collateral circulation on all 30 patients including one patient with falsely normal MRI. Conclusion The clinical manifestations of CVT are not specific. CT, MRI and MRV are noninvasive and sensitive whereas MRI combined with MRV is most accurate for diagnosing CVT.