Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis

Patel, Deelan; Machnowska, Matylda; Symons, Sean; Yeung, Robert; Fox, Allan J.; Aviv, Richard I.; Maralani, Pejman Jabehdar

doi:10.3174/ajnr.a4843

Cited by 42 publications

(37 citation statements)

References 21 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: 94%

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: 94%

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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“…Dedicated MR venography sequences may be useful in cases of skull fracture involving dural sinuses, as they are highly sensitive to the presence of DVST. Although each MR imaging sequence has varying strengths and weaknesses in the detection of DVST, a combination of conventional MR imaging sequences performs best, with sensitivity of 79% and specificity of 90% in one study (47) and a sensitivity greater than 99% in another study (although with low specificity) (48).…”

Section: Screening By Modalitymentioning

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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“…The structural imaging [head computed tomography (CT) and routine brain magnetic resonance imaging (MRI)] can assess any parenchymal lesion secondary to the venous thrombosis and reveal direct signs of intraluminal thrombus ( 3 ). As some special MRI sequences, such as susceptibility-weighted images, are used in routine MRI protocols to detect the presence of intraluminal thrombus, many patients can be diagnosed with CVT more rapidly and directly by structural imaging in recent years ( 4 , 5 ). On the other hand, although the parenchymal lesions are not specific, they could draw attention and prompt a search for direct visualization of a thrombus on MRI or ordering a venography.…”

Section: Introductionmentioning

confidence: 99%

The Structural Imaging Characteristics and Its Clinical Relevance in Patients with Cerebral Venous Thrombosis—A Retrospective Analysis from One Single Center in China

et al. 2017

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BackgroundFew studies have investigated structural imaging findings of cerebral venous thrombosis (CVT) in China. The structural imaging [head computed tomography (CT) and routine brain magnetic resonance imaging (MRI)] can assess any parenchymal lesion secondary to the venous thrombosis and reveal direct signs of intraluminal thrombus. In recent years, many patients can be diagnosed with CVT more rapidly and directly by structural imaging. The aim of the present study is to determine the performance of structural imaging in the diagnosis and outcome of CVT in a large cohort single center of Chinese patients.MethodsWe evaluated consecutive patients admitted to our hospital with CVT receiving structural imaging from 1991 to 2015. A neuroradiologist, blinded to clinical data, independently reviewed the structural imaging, including head CT and routine MRI for parenchymal lesions and signs of dural venous sinus thrombosis, as well as the MRV/DSA findings. The Clinical and laboratory data were reviewed and recorded for further analysis.Results117 patients were included in this study, 68 (58.1%) were females. Parenchymal lesions were identified in 56.4% (66/117) of the patients on structural imaging, including focal edema in 30.8%, hemorrhage in 19.7%, and brain swelling in 4.3% of the patients. Patients with parenchymal lesions presented with more often seizures (P < 0.001) and less often headache (P = 0.049). Intraluminal thrombus within the sinuses or veins on structural imaging was found in 28.2% (33/117) of the patients. Patients with both intraluminal thrombus and parenchymal lesions on structural imaging had more acute onset (P = 0.01) and present more consciousness disturbance (P = 0.007).ConclusionIntracranial lesions on structural imaging are frequently found in patients with CVT. Patients with parenchymal lesions on structural imaging, especially with intraluminal thrombus simultaneously, tend to have a severe clinical picture and might lead to a devastating or fatal outcome. Structural imaging may help on early diagnosis and predict the poor outcome of CVT.

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Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis

Abstract: Routine MR images can suggest dural venous sinus thrombosis with high specificity in high-risk patients, even in cases without clinical suspicion.

Cited by 42 publications

References 21 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

The Structural Imaging Characteristics and Its Clinical Relevance in Patients with Cerebral Venous Thrombosis—A Retrospective Analysis from One Single Center in China

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