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。     

颅内静脉窦血栓形成的MRI和MRV表现

目的探讨颅内静脉窦血栓形成的MRI和MRV（磁共振静脉成像）表现特点。方法回顾分析20例颅内静脉窦血栓形成患者的MRI和MRV表现。20例均行常规MRI,10例行MRI增强,15例行MRV检查（2DTOF）。结果20例常规MRI榆查中,12例静脉窦内正常流空效应消失,T1WI,T2WI和FLAIR静脉赛内见等、高或低信号,3例静脉宴内未见明屁异常信号但伴有腑组织水肿、出血、梗死及脑积水。5例海绵窦区T1WI见稍低或等信号,T2WI见高信号并可见强化．15例MRV见静脉窦高信号缺失、静脉窦粗细不规则、静脉窦内充盈缺损。结论MRI和MRV相互结合可有助于对顿内静咏窦血栓形成的早期作出正确诊断。     

硬脑膜窦血栓形成磁共振成像诊断

目的　总结硬脑膜窦血栓形成 (DST)头颅MRI及MRV表现特点。方法　回顾分析 2 0例DST患者的MRI及MRV表现。结果　MRI典型表现为硬脑膜窦内正常流空效应消失 ,代之以异常等信号或高信号影。病变好发部位依次为横窦 -乙状窦、上矢状窦、直窦 ,部分患者伴有皮质引流静脉及脑深部大静脉受累。MRV示受累静脉窦全程或节段性闭塞 ,病变部位和范围与MRI所见基本一致。结论　MRI及MRV可直接识别血栓 ,是目前无创性诊断DST的最可靠方法。     

动态3D CE-MRV在颅内疾病诊断及治疗中的应用初探

目的：探讨动态3D CE-MRV在颅内静脉系统疾病诊断中的成像优势及其对颅内疾病临床诊断及治疗的指导意义.方法：可疑或确诊为颅内静脉病变者36例应用3T磁共振仪及3D TRICK技术行动态CE-MRV检查,9例无颅内静脉病变者同时行2D TOF序列MRV检查.分析动态3D CE-MRV图像,观察颅内深浅静脉系统主干及其分支的显示情况,比较其相对于2D TOF序列MRV的优势;分析动态3D CE-MRV对颅内疾病如静脉窦及静脉血栓、累及静脉的血管畸形、肿瘤和外伤等的诊断价值及其对临床治疗的指导意义.结果：与2D TOF序列比较,3D CE-MRV对静脉窦属支、上下吻合静脉及海绵窦等显示更清晰（P〈0.05）.动态CE-MRV显示36例受检者大致可分为4种结果：①正常者16例,含静脉发育变异6例;②累及静脉的颅内血管畸形3例;③静脉窦或静脉血栓11例,其中3例为溶栓术后复查显示再通;④肿瘤及外伤6例：脑膜瘤或颈静脉球瘤压迫或侵犯静脉窦者3例;外伤致颅内静脉异常者3例,其中1例为颈内动脉海绵窭瘘.结论：动态3D CEMRV对颅内静脉尤其是细小静脉的观察明显优于2D TOF序列的MRV;多时相显影和多方位重组可对颅内静脉变异、静脉畸形和累及静脉的疾患能清晰显示,为临床诊断、治疗方案的确定及疗效评价提供重要的影像依据.     

脑静脉窦和深静脉血栓形成的

探讨脑静脉窦和深静脉血栓形成的cT与MRI表现特点。回顾性分析22例脑静脉窦和深静脉血栓患者的头颅CT、MRI影像学表现。受累静脉窦或静脉系统：上矢状窦血栓18例，右侧横窦14例，左侧横窦13例，右侧乙状窦10例，左侧乙状窦6例，直窦血栓5例，2例合并大脑内静脉血栓形成。14次CT平扫,9次出现直接征象（急性期3次，亚急性期6次）；22次MRI平扫，12次出现流空信号消失，表现为高信号三角征（急性期5次，亚急性期6次，慢性期1次），5次增强MRI显示空三角征，21次MRv显示受累的静脉窦或静脉不显影。CT与MRI（MRV）检查是诊断静脉血栓形成可靠的手段。对急性静脉血栓形成者，CT是一种简单有效的诊断方法；对于亚急性期、慢性期CVT者，MRI、MRV检杏具有优势。     

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。     

脑静脉窦和深静脉血栓形成的CT和MRI诊断

探讨脑静脉窦和深静脉血栓形成的CT与MRI表现特点。回顾性分析22例脑静脉窦和深静脉血栓患者的头颅CT、MRI影像学表现。受累静脉窦或静脉系统:上矢状窦血栓18例,右侧横窦14例,左侧横窦13例,右侧乙状窦10例,左侧乙状窦6例,直窦血栓5例,2例合并大脑内静脉血栓形成。14次CT平扫,9次出现直接征象(急性期3次,亚急性期6次);22次MRI平扫,12次出现流空信号消失,表现为高信号三角征(急性期5次,亚急性期6次,慢性期1次),5次增强MRI显示空三角征,21次MRV显示受累的静脉窦或静脉不显影。CT与MRI(MRV)检查是诊断静脉血栓形成可靠的手段。对急性静脉血栓形成者,CT是一种简单有效的诊断方法;对于亚急性期、慢性期CVT者,MRI、MRV检查具有优势。     

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.     

颅内静脉系统血栓形成17例临床分析

目的探讨颅内静脉系统血栓形成的临床特征。方法回顾性分析自2012年6月至2016年12月沈阳军区总医院神经外科收治的17例颅内静脉系统血栓形成患者的临床资料,分析颅内静脉系统血栓形成的特点及疗效。结果本组17例患者主要累及上矢状窦、横窦、乙状窦、直窦等部位。其中,4例接受介入溶栓术,13例接受抗凝治疗。17例患者中,15例(88.2%)患者好转痊愈,患者临床症状基本消失,出血者头颅CT复查血肿吸收,核磁共振成像+磁共振静脉显影(MRV)显示静脉窦完全再通,2例(11.8%)病重放弃治疗。结论对怀疑静脉系统血栓形成患者采用MRV或CT静脉显影或数字减影全脑血管造影(DSA)检查等影像学检查可明确诊断,及时给予对症药物抗凝或介入治疗,预后良好。     

64层CT正常颅内静脉成像

目的观察横窦和小脑幕侧窦的常见形态、变异及其临床意义．比较最大密度投影（MIP）和容积再现（VR）对颅内静脉（窦）结构的显示率。资料与方法25例CT脑静脉成像（CTV）．分别观察VR、MIP对13个颅内静脉（窦）的显示情况。结果25例总共显示494个结构。VR显示481个,MIP显示431个,经X^2检验差异有统计学意义（P〈0．001）。上矢状窦、直窦、窦汇、大脑大静脉、海绵窦、大脑内静脉和下矢状窦在VR、MIP两种重组方法中显示率均为100％。大脑中浅静脉、岩下窦、Labbe静脉、Trolard静脉VR优于MIP。小脑幕侧窦两者未见显著性差异。左侧横窦优势型4例,右侧横窦优势型11例,其中横窦发育不良2例,10例为中间型。小脑幕侧窦可分三型。结论CTV可较完整地显示颅内静脉及静脉窦,显示颅内静脉（窦）VR优于MIP;正确认识横窦、小脑幕侧窦的形态有重要的临床意义。     

Cerebral MR venography: normal anatomy and potential diagnostic pitfalls

BACKGROUND AND PURPOSE: MR venography is often used to examine the intracranial venous system, particularly in the evaluation of dural sinus thrombosis. The purpose of this study was to evaluate the use of MR venography in the depiction of the normal intracranial venous anatomy and its variants, to assess its potential pitfalls in the diagnosis of dural venous sinus thrombosis, and to compare the findings with those of conventional catheter angiography. METHODS: Cerebral MR venograms obtained in 100 persons with normal MR imaging studies were reviewed to determine the presence or absence of the dural sinuses and major intracranial veins. RESULTS: Systematic review of the 100 cases revealed transverse sinus flow gaps in 31% of the cases, with 90% of these occurring in the nondominant transverse sinus and 10% in the codominant transverse sinuses. No flow gaps occurred in the dominant transverse sinuses. The superior sagittal and straight sinuses were seen in every venogram; the occipital sinus was seen in only 10%. The vein of Galen and internal cerebral veins were also seen in every case; the basal veins of Rosenthal were present in 91%. CONCLUSIONS: Transverse sinus flow gaps can be observed in as many as 31% of patients with normal MR imaging findings; these gaps should not be mistaken for dural sinus thrombosis.     

Cerebral MR venography in children: comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques

PURPOSE: To prospectively compare two-dimensional (2D) time-of-flight cerebral magnetic resonance (MR) venography with gadolinium-enhanced three-dimensional (3D) gradient-echo cerebral MR venography in children. MATERIALS AND METHODS: This investigation had investigational review board approval and was Health Insurance Portability and Accountability Act compliant; parental informed consent was obtained. Thirty-seven patients (20 boys, 17 girls) who ranged in age from 4 days to 15 years underwent 2D and 3D MR venography. Two pediatric neuroradiologists compared the visibility of the superior sagittal, straight, transverse, and sigmoid sinuses and the internal jugular veins on images obtained with the two sequences. RESULTS: In 17 (46%) of the 37 patients, the sequences were equivalent in terms of their depiction of venous anatomy. In 19 (51%) of the 37 patients, 3D MR venography was superior to 2D MR venography. Suboptimal enhancement of veins occurred in one (3%) patient at 3D MR venography. Venous anomalies suggested at 2D MR venography but not present at 3D MR venography included flow gaps in the nondominant transverse sinuses of four patients, unilateral transverse sinus atresia in eight, and a narrowed superior sagittal sinus in two. Two-dimensional MR venography results failed to reveal a persistent falcine sinus associated with straight sinus atresia in one patient and suggested transverse sinus thrombosis in two patients in whom 3D MR venography results were normal. Additionally, the extent of dural thrombosis was overestimated at 2D MR venography in one patient. As compared with 3D MR venography, 2D MR venography failed to reveal sigmoid sinus stenosis in one patient and poorly depicted posterior fossa dural sinus anatomy in two patients with dural arteriovenous fistula. CONCLUSION: Three-dimensional MR venography is often superior to 2D MR venography in the delineation of major cerebral venous structures in children. Most of the artifactual loss of vascular signal seen with the use of 2D MR venography occurred in nondominant transverse sinuses.     

静脉性脑梗死MR影像特点

目的回顾总结静脉性脑梗死MRI及MRV影像表现,旨在提高影像诊断水平。方法对15例静脉性脑梗死的MR表现进行了回顾性分析,其中9例临床治疗后复查MR表现明显好转,临床症状明显改善。15例均行常规MRI平扫,其中9例同时进行MR增强及3DCE-MRV,6例行2DTOF MRV。结果 15例脑内多发病灶9例,单发病灶6例,其中2例脑梗死伴出血改变。15例中发生于额叶4例,顶叶6例,颞叶3例,枕叶1例,小脑1例。静脉栓塞部位11例为上矢状窦,1例直窦及左横窦,1例右侧横窦及乙状窦,2例皮层大脑浅静脉。9例行增强扫描,5例病灶内不规则强化,2例脑膜强化,3例无强化.7例MRV均显示栓塞的静脉血流信号丢失或缺损,3例出现异常静脉侧支或引流静脉异常扩张。结论静脉性脑梗死MR影像表现具有特征性,MRI结合MRV可以作为首选的无创检查方法,对静脉栓塞早期诊断和治疗有重要作用。     

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.     

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.     

MR venography in the pediatric patient

BACKGROUND AND PURPOSE: Little is known about age-related changes in posterior fossa venous anatomy on 2D time-of-flight MR venography (MRV) or about artifacts that limit its accuracy in diagnosing venous occlusive disease. We evaluated pediatric appearances of posterior fossa venous drainage. METHODS: One hundred and eight children with normal MR imaging or minimal congenital anomalies underwent 2D MRV. Transverse sinus dominance and absence and the presence of an occipital sinus were correlated with age. Venous structure conspicuity was compared on source and maximum intensity projection images. RESULTS: Right, left, and codominance of the transverse sinus, respectively, was as follows: at < 25 months, 37%, 21%, and 42%; 25 months to 5 years, 35%, 30%, 35%; and > or =6 years, 50%, 16%, 34%. Transverse sinus dominance was not related to age between the three groups (P=.58, chi-square contingency), but some relationship was observed when patients <6 years were compared to those > or =6 years (P=.032). Chi-square trends showed a mildly positive correlation between age and an absent transverse sinus (P=.026) and a decreasing trend in the presence of an occipital sinus with age (P=.038). Saturation effects due to in-plane/slow flow were worse in patients <25 months; effects in the transverse sinuses or internal jugular veins were miminized with coronal or axial imaging, respectively. CONCLUSION: 2D TOF MRV shows age-related changes in venous anatomy. Caution should be used before posterior fossa venous occlusive disease is diagnosed on the basis of signal intensity loss, especially in neonates and young infants.     

Partially recanalized chronic dural sinus thrombosis: findings on MR imaging, time-of-flight MR venography, and contrast-enhanced MR venography

BACKGROUND AND PURPOSE: The imaging appearance of chronic, partially recanalized dural sinus thrombosis has been incompletely described. We sought to more fully characterize the imaging findings of this entity on MR imaging, time-of-flight MR venography (TOF-MRV), and elliptic centric-ordered contrast-enhanced MR venography (CE-MRV). Materials and METHODS: From a data base of patients with cerebral venous thrombosis, 10 patients were identified with imaging and clinical findings consistent with the diagnosis of chronic, partially recanalized, dural sinus thrombosis. All patients had MR imaging of the brain without and with contrast. Nine patients underwent MRV, and 6 had both CE-MRV and TOF-MRV. Thirty-four venous segments were thrombosed and were assessed in detail for multiple imaging features. RESULTS: Most thrombosed segments were isointense to gray matter on T1-weighted images (85%), and hyperintense to gray matter on T2-weighted images (97%). Visible serpiginous intrathrombus flow voids were visible in 23 segments (8/10 patients) corresponding with areas of flow signal intensity on TOF-MRV and enhancing channels on contrast MRV. Eighty-four percent of thrombosed segments enhanced equal to or greater than venographically normal venous sinuses. TOF-MRV and CE-MRV were abnormal in all patients, and CE-MRV more completely characterized the thrombosed segments. The imaging appearance did not change in those patients with follow-up imaging (average 13.6 months). CONCLUSION: Chronic, partially recanalized, venous thrombosis has a characteristic appearance on MR and MRV. CE-MRV was abnormal in all cases, despite the intense enhancement of the thrombosed segments. Because of the highly selected nature of the cases reported, further study is required to determine whether these findings are present in all cases of this condition.     

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.