Cryptic asymptomatic parasellar high signal on time-of-flight MR angiography: how to resolve the clinical conundrum

Lim, Kheng Choon; Raj, Santhosh; Kee, Tze Phei; Sim, Samantha Xue-Li; Mien, Ivan Ho; Ho, Jamie X; McAdory, Louis Elliott; Lim, Winston Eng Hoe; Chan, Ling‐Ling

doi:10.1007/s00234-020-02482-0

Cited by 2 publications

(2 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are considered to indicate flow signals in the PP/emissary vein (EV) originating from the reverse flow, as in the internal jugular vein (IJV) and SS. Although previous investigators described the pathological and non-pathological imaging features of incidental high signal in the CS on MRA [5], it is sometimes difficult to differentiate a high signal originating from the reverse flow on MRA and occult CS-DAVF. In a clinical setting, a diagnosis of simply "suspected occult CS-DAVF" would indicate the need for long-term followup or further examinations with another imaging technique.…”

Section: Introductionmentioning

confidence: 99%

High-signal venous sinuses on MR angiography: discrimination between reversal of venous flow and arteriovenous shunting using arterial spin labeling

et al. 2020

View full text Add to dashboard Cite

Purpose It is sometimes difficult to differentiate between high signals originating from a reverse flow on magnetic resonance angiography (MRA) and occult arteriovenous shunting. We attempted to determine whether arterial spin labeling (ASL) can be used to discriminate reversal of venous flow from arteriovenous shunting for high-signal venous sinuses on MR angiography. Methods Two radiologists evaluated the signals of the venous sinus on MRA and ASL obtained from 364 cases without arteriovenous shunting. In addition, the findings on MRA were compared with those on ASL in an additional 13 patients who had dural arteriovenous fistula (DAVF). Results In the 364 cases (728 sides) without arteriovenous shunting, a high signal due to reverse flow in the cavernous sinuses (CS) was observed on 99 sides (13.6%) on MRA and none on ASL. Of these cases, a high signal in the sigmoid sinus, transverse sinus, and internal jugular vein was seen on 3, 3, and 8 sides, respectively. All of these venous sinuses showed a high signal from the reverse flow on MRA images. Conclusion ASL is a simple and useful MR imaging sequence for differentiating between reversal of venous flow and CS DAVF. In the sigmoid and transverse sinus, ASL showed false-positives due to the reverse flow from the jugular vein, which may be a limitation of which radiologists should be aware.

show abstract

Section: Introductionmentioning

confidence: 99%

High-signal venous sinuses on MR angiography: discrimination between reversal of venous flow and arteriovenous shunting using arterial spin labeling

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Another potential consideration that nonpathologic caudocranial venous flow from the sphenoparietal sinus shows high-signal intensity on TOF MRA and can be readily recognized by its characteristic parasellar location. 43 Other commonly noted artifacts in TOF MRA such as the in-plane saturation artifact, shine-through artifact, and susceptibility artifact have limited effects on the interpretation of flow-related signals—especially when using the source images—and therefore, could be neglected in this study.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Reflux and Cerebral Amyloid Angiopathy: An Magnetic Resonance Imaging/Positron Emission Tomography Study

Lee

Tsai

Liu

et al. 2023

Stroke

View full text Add to dashboard Cite

Background: Cerebral venous outflow alterations contribute to central nervous system pathology in aging and neurodegenerative disorders and are potentially linked to underlying cerebral microangiopathy. We investigated whether cerebral venous reflux (CVR) is more closely associated with cerebral amyloid angiopathy (CAA) than hypertensive microangiopathy in intracerebral hemorrhage (ICH) survivors. Methods: This cross-sectional study included 122 patients of spontaneous ICH with magnetic resonance and positron emission tomography imaging studies (2014–2022) in Taiwan. The presence of CVR was defined as abnormal signal intensity in the dural venous sinus or internal jugular vein on magnetic resonance angiography. Cerebral amyloid load was measured using the Pittsburgh compound B standardized uptake value ratio. Clinical and imaging characteristics associated with CVR were evaluated in univariable and multivariable analyses. In the subset of patients with CAA, we applied univariable and multivariable linear regression analyses to evaluate the association between CVR and cerebral amyloid retention. Results: Compared with patients without CVR (n=84, 64.5±12.1 years), patients with CVR (n=38, 69.4±11.5 years) were significantly more likely to have CAA-ICH (53.7% versus 19.8%; P< 0.001) and had a higher cerebral amyloid load (standardized uptake value ratio [interquartile range], 1.28 [1.12–1.60] versus 1.06 [1.00–1.14]; P< 0.001). In a multivariable model, CVR was independently associated with CAA-ICH (odds ratio, 4.81 [95% CI, 1.74–13.27]; P= 0.002) after adjustment for age, sex and conventional small vessel disease markers. In CAA-ICH, higher PiB retention was observed in patients with CVR than patients without CVR (standardized uptake value ratio [interquartile range], 1.34 [1.08–1.56] versus 1.09 [1.01–1.26]; P <0.001). In multivariable analysis after adjustment for potential confounders, the presence of CVR was independently associated with a higher amyloid load (standardized β=0.40; P =0.001). Conclusions: In spontaneous ICH, CVR is associated with CAA and a higher amyloid burden. Our results suggest venous drainage dysfunction potentially plays a role in CAA and cerebral amyloid deposition.

show abstract

Cryptic asymptomatic parasellar high signal on time-of-flight MR angiography: how to resolve the clinical conundrum

Cited by 2 publications

References 28 publications

High-signal venous sinuses on MR angiography: discrimination between reversal of venous flow and arteriovenous shunting using arterial spin labeling

High-signal venous sinuses on MR angiography: discrimination between reversal of venous flow and arteriovenous shunting using arterial spin labeling

Cerebral Venous Reflux and Cerebral Amyloid Angiopathy: An Magnetic Resonance Imaging/Positron Emission Tomography Study

Contact Info

Product

Resources

About