脑静脉(窦)血栓形成的影像学特点

目的:探讨脑静脉(窦)血栓形成(CVST)的影像学表现。方法:回顾性分析61例CVST患者的头颅CT、MRI、磁共振静脉血管造影(MRV)及数字减影血管造影(DSA)表现。结果:分别有61、49及59例患者行头颅CT、MRI及DSA检查。6例(6/7)急性患者,CT存在直接和间接征象,而11例(11/13)亚急性与33例(33/41)慢性患者CT无异常。急性与慢性患者MRI主要表现为静脉窦内T1低信号、T2高信号,亚急性期主要是T1、T2高信号。随着病程延长,静脉性脑梗死发生率下降(3/6,5/11,6/32),但空蝶鞍的机率增加(0,1/11,10/32)。8例行MRV检查的患者,均发现静脉(窦)充盈缺损或中断。MRI结合MRV技术可对行MRI检查的49例患者中的35例进行确诊,但11例慢性与3例亚急性患者,CT、MRI(V)均未发现异常,行DSA检查才得以确诊。结论:对急性CVST而言,头颅CT是一种简单、有效的诊断方法;而对亚急性与慢性患者,MRI具有更高敏感度与特异性;MRV可快速、无创地诊断CVST。如果头颅CT、MRI、MRV仍不能明确诊断,应尽快行DSA检查,尤其是皮层静脉以及深静脉血栓形成患者。

Imaging characteristics of cerebral venous(sinus) thrombosis

Objective: To discuss the imaging feature of cerebral venous(sinus ) thrombosis (CVST). Methods: The feature of CT, MRI, magnetic resonance venogra phy(MRV) and DSA in 61 cases with CVST were reviewed. Results: There were 61, 49 and 59 cases examined by CT, MRI and DSA respectively. In the acute phase, 6/7 cases showed the direct and indirect CVST signs by CT scanning, but 11/13 subacu te and 33/41 chronic patients had no abnormality. In the acute and chronic phase , thrombosis in the sinus appeared as hypointense in T1- and hyperintense in T2- weighted spin-echo images. In the subacute phase, the thrombosis became hyperint ense in T1- and T2-weighted spin-echo images. As the disease progressed, venous infarction decreased, but the empty sella turcica increased. MRI and MRV togethe r provided the diagnosis of CVST in 35/49 cases. In 11 chronic and 3 subacute pa tients whose CT and MRI(V) were normal, DSA made the diagnosis of CVST. Conclusi on: CT is a simple and effective method to diagnose acute CVST. MRI is sensitive and exceptional to the diagnosis of CVST. MRV can evaluate venous and sinus thr ombosis quickly and non-invasively. If CT, MRI and MRV can not make a clear diag nosis, the patient need a DSA inspection, especially for cortex and deep venous thrombosis.