Diagnostic Performance of MRI Sequences for Evaluation of Dural Venous Sinus Thrombosis

Sadigh, Gelareh; Mullins, Mark E.; Saindane, Amit M.

doi:10.2214/ajr.15.15719

Cited by 47 publications

(36 citation statements)

References 18 publications

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“…12 These studies are congruent in their findings but include mixed populations of patients and pathologies and not specifically postoperative cases. 19,20 Further, it is important to note that the imaging modalities utilized in our study, specifically contrast-enhanced MRI, is unable to delineate if the thrombi are flow limiting. A thrombus causing total occlusion versus a flow limiting thrombus may have different clinical consequences.…”

Section: Discussionmentioning

confidence: 95%

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Brahimaj

Beer‐Furlan

Crawford

et al. 2019

J Neurol Surg B Skull Base

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Introduction Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic; however, there is limited data on the incidence, clinical progression, and proper management of this patient population. Methods A retrospective review was performed for patients undergoing surgery for VS at a single institution. All postoperative imaging was reviewed for incidence of DVST. Demographic data were collected including tumor and surgical characteristics along with postoperative course. Results A total of 63 patients underwent resection of their VS. The incidence of DVST was 34.9%. The operative time was greater in the dural venous sinus thrombosis (DSVT) group, at an average of 6.69 hours versus 4.87 in the no DSVT cohort (p = 0.04). Tumor size was correlationally significant (p = 0.051) at 2.75 versus 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was most commonly involved (95.5%). Of them, 85% patients had a codominant or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in five (22.7%) of the patients on last follow-up imaging. There were no hemorrhagic complications. Conclusion The overall incidence of DVST was (34.9%) of 63 patients who underwent VS surgery. All patients were asymptomatic and none were treated with anticoagulation. In our study, continuing to observe asymptomatic patients did not lead to any adverse events.

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Section: Discussionmentioning

confidence: 95%

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Brahimaj

Beer‐Furlan

Crawford

et al. 2019

J Neurol Surg B Skull Base

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“…T2*-weighted images may show blooming of susceptibility artifact within the clot. Of note, an enhanced T1-weighted 3D volumetric gradientecho sequence has been shown to be the single most sensitive and specific MR imaging sequence for the detection of DVST, demonstrating a filling defect at the site of the clot (48).…”

Section: Venous Injurymentioning

confidence: 99%

Imaging and Management of Blunt Cerebrovascular Injury

2018

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Blunt cerebrovascular injury (BCVI) is a relatively rare but potentially devastating finding in patients with high-energy blunt force trauma or direct cervical and/or craniofacial injury. The radiologist plays an essential role in identifying and grading the various types of vascular injury, including minimal intimal injury, dissection with raised intimal flap or intraluminal thrombus, intramural hematoma, pseudoaneurysm, occlusion, transection, and arteriovenous fistula. Early identification of BCVI is important, as treatment with antithrombotic therapy has been shown to reduce the incidence of postinjury ischemic stroke. Patients with specific mechanisms of injury, particular imaging findings, or certain clinical signs and symptoms have been identified as appropriate and cost-effective for BCVI screening. Although digital subtraction angiography was previously considered the standard examination for screening, technologic improvements have led to its replacement with computed tomographic angiography. Of note, although not appropriate for screening, improvements in magnetic resonance angiography with vessel wall imaging hold promise as supplemental imaging studies that may improve diagnostic specificity for vessel wall injuries. Understanding the screening criteria, imaging modalities of choice, imaging appearances, and grading of BCVI is essential for the radiologist to ensure fast and appropriate diagnosis and treatment. This article details the imaging evaluation of BCVI and discusses the clinical and follow-up imaging implications of specific injury findings. RSNA, 2018.

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“…Cerebral venous thrombosis includes thrombosis of the dural venous sinuses and other venous structures of the brain. MRI and MRV are, on average, slightly more sensitive than CT and CT venography for the detection of cerebral venous thrombosis, but may be more susceptible to artifacts . On unenhanced MRI, dural sinus thrombus will change in signal intensity based on clot age.…”

Section: Dural Venous Sinus Variations and Related Pathologymentioning

confidence: 99%

Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings

Freeman

Lazor

Loevner

et al. 2019

Journal of Neuroimaging

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Variations in the venous drainage of the central nervous system can have imaging and clinical findings that mimic pathology, presenting a challenge for neuroimagers and clinicians. Patients with these variants may undergo unnecessary testing, and patients with pathology may receive delayed diagnoses because of overlap with benign findings. Consequently, the accurate identification of venous variations on cross-sectional imaging and angiography and their potential causes are critical for differentiating benign imaging variants from potential pathologic processes requiring further evaluation. For example, in the epidural space, benign dilation of the epidural venous plexus may be mistaken for evidence of a fistula, abscess, or metastasis. Hypoplasia of a dural venous sinus or an arachnoid granulation may mimic venous sinus thrombosis. The superior ophthalmic vein may demonstrate benign dilation in intubated patients, mimicking thrombosis, increased intracranial pressure, orbital varix, inflammatory pseudotumor, or other conditions. Furthermore, certain venous variations, such as the occipital sinus or emissary veins, may complicate surgery or herald pathology and should be reported. In addition, some supposedly benign variations, such as the developmental venous anomaly, can be complicated by pathology. The objective of this review article is to provide a descriptive and pictorial review of common anatomic and physiologic variations in the venous drainage system of the brain, spine, and orbits that can mimic pathology. Neuroimaging findings of related pathologies and differences in clinical presentations will also be discussed to assist in the approach to differential diagnosis.

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Diagnostic Performance of MRI Sequences for Evaluation of Dural Venous Sinus Thrombosis

Abstract: Sequences used in routine brain MRI performed with and without contrast enhancement have varying strengths that are important to recognize when the likelihood of DVST is assessed, but they do not replace the utility of dedicated CE MRV.

Cited by 47 publications

References 18 publications

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Imaging and Management of Blunt Cerebrovascular Injury

Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings

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