Diagnostische Wertigkeit des kombinierten Einsatzes von Kernspintomo- und Kernspinangiographie bei Sinusvenenthrombosen (SVT)

Abstract

25 patients are presented, who were diagnosed with cerebral sinus venous thrombosis by a combination of Magnetic Resonance Angiography (MRA) and conventional Spin-Echo sequences. An angiography in DSA technique was carried out additionally in 12 cases. In 24 patients MR-angiographic control examinations were conducted. In seven cases MRA revealed an isolated thrombosis of the superior sagittal sinus (SSS) whereas in eleven patients there was an additional occlusion of other sinuses or cerebral veins. The transverse sinus (ST) was the second most affected. DSA essentially confirmed the MR-imaging data. Despite anticoagulation follow up MRA's showed complete recanalisation in only 7 patients, in 8 cases partial recanalisation was observed and in 9 cases a complete occlusion persisted. In contrast to these findings neurological examinations during the follow up period were unremarkable in 16 patients and the remainder revealed only mild residual symptoms. In general no further morphological alterations of the cerebral sinus system were detectable by MRA after 6 months. Follow up imaging beyond 6 months therefore appears unnecessary, unless a relapse is suspected.

Recanalization and outcomes after cerebral venous thrombosis: a systematic review and meta-analysis

“…The minimum duration of anticoagulation was between 3 and 12 months in all studies, except 1 study whose treatment duration ranged as short as 1 month and 2 studies whose minimum treatment was 2 months [ [12] , [13] , [14] ]. Seven studies did not state the duration of treatment [ [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. When anticoagulation details were provided (20 of 23 studies), treatment was initiated with heparin/low molecular weight heparin, then maintenance oral anticoagulation with: vitamin K antagonists (10 of 23 studies, direct oral anticoagulants (DOACs; 2 of 23 studies); oral anticoagulation unspecified (4 of 23 studies, or assigned to either vitamin K antagonists versus DOAC (3 of 23 studies).…”

“…One study clearly stated that all participants were immediately started on a DOAC after diagnosis [ 20 ]. Three studies did not provide any details on the anticoagulation treatment [ [17] , [18] , [19] ]. All studies used a combination of CT venography, MR venography, and at times additional conventional angiography for baseline and follow-up neuroimaging asides for 1 study which utilized T1, T2, and spin echo sequences on MR for baseline and follow-up imaging [ 24 ].…”

“…Overall, 21 studies reported the relationship between recanalization and prognosis with the mRS ( Table 1 ). In total, 18 studies with 735 included patients had data suitable for calculating pooled ORs for no versus any recanalization in relation to functional outcome as per mRS [ 10 , [12] , [13] , [14] , [15] , [16] , [17] , [18] , 20 , 21 , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. An additional study reported data from 508 patients [ 11 ] suitable for pooling with the other studies using inverse variance weighting.…”

“…An additional study reported data from 508 patients [ 11 ] suitable for pooling with the other studies using inverse variance weighting. Overall, 14 studies with 564 included patients in total had data suitable for calculating pooled ORs by degree of recanalization [ [15] , [16] , [17] , [18] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [28] , [29] , [30] ]. When examining the effect sizes related to functional outcome and recanalization, the funnel plot was symmetric on visual inspection, and Egger’s test was not significant ( Figure S2 , Supplementary Material ).…”

“…Three studies including 65 patients reported the relationship between recanalization and epilepsy [ 18 , 21 , 30 ]. Two others reported rates of epilepsy without data suitable for OR pooling [ 14 , 29 ].…”