Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist

Pai, Vivek; Khan, Iram; Sitoh, Yih Yian; Purohit, Bela

doi:10.25259/jcis_187_2020

Cited by 12 publications

(5 citation statements)

References 31 publications

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“…The spread of mucormycosis from the orbit and orbital apex involves the cavernous sinus, which leads to thrombosis with loss of flow void and convex margin of the sinus 12 . Mucormycosis has a high propensity for arterial invasion as it reproduces in the internal elastic layer of vessels causing separation of the elastic and middle layers with intimal damage and thrombosis 19 . Cerebral infarction due to purulent arteritis and inflammatory emboli was reported by Ma et al .…”

Section: Discussionmentioning

confidence: 99%

Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study

Paudel,

Regmi,

Kayastha

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease. Materials and methods: This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel’s cave, and the brain parenchyma. Results: The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients. Conclusion: The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.

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Section: Discussionmentioning

confidence: 99%

Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study

Paudel,

Regmi,

Kayastha

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Contrast-enhanced MRV has a sensitivity and specificity comparable to that of CTV but allows better characterization between the low-flow state and hypoplastic sinus (flow gaps). 39 Contrast-enhanced techniques and gradient-recalled echo or susceptibility-weighted imaging are recommended for diagnosing cortical vein thrombosis (new evidence since the 2011 American Heart Association statement). 1,34,37…”

Section: Confirming the Diagnosis Of Cvtmentioning

confidence: 99%

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

Saposnik,

Bushnell,

Coutinho

et al. 2024

Stroke

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Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.

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“…Partial or complete encasement of the cavernous part of the internal carotid artery by the soft tissue or thrombus present in the cavernous sinus may lead to luminal narrowing. There is a high propensity for arterial invasion by the Mucorales due to its ability to bind to the endothelium through specific receptors and invade the internal elastic lamina causing intimal damage and thrombosis [ 31 , 32 ]. The vessel wall invasion can cause vasculitis without any visible thrombus which appears as mural thickening and vessel wall enhancement on post-contrast images.…”

Section: Main Textmentioning

confidence: 99%

Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay

Agrawal

Tripathi

Shukla

et al. 2022

Egypt J Radiol Nucl Med

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Rhinocerebral mucormycosis has emerged as a common coinfection in coronavirus disease 2019 (COVID-19) patients during the convalescence period. Frequent spread of disease from sinonasal mucosa to bone, neck spaces, orbit, and brain occurs along the perivascular/perineural routes or through direct invasion. Brain involvement represents severe manifestation and is often associated with poor functional outcomes and high mortality rates. Magnetic resonance imaging (MRI) is the modality of choice for the intracranial assessment of disease severity in mucormycosis. Early and accurate identification of intracranial extension is imperative to improve survival rates. With this pictorial essay, we aim to familiarize the readers with the cross-sectional imaging features of intracranial complications of mucormycosis. The radiological details in this essay should serve as a broad checklist for radiologists and clinicians while dealing with this fulminant infection.

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Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist

Cited by 12 publications

References 31 publications

Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study

Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay

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