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.