Use of Magnetic Resonance Imaging and Magnetic Resonance Angiography in Diagnosis of Sigmoid Sinus Thrombosis

Abstract

Magnetic resonance angiography is an established radiologic technique which is rapidly becoming useful in imaging the head and neck. Currently, this imaging modality is important in the diagnosis of sigmoid sinus thrombosis caused by otologic disease. Since the introduction of antibiotic therapy, the percentage of deaths attributed to intracranial complications from otitic disease has decreased from 2.5 to approximately 0.25% of documented deaths. Also, the incidence of sinus thrombosis within this group has decreased, but it is still a serious and potentially lethal condition. Sinus thrombosis is suspected clinically when mastoid disease progresses, with picket fence fever pattern, chills, headaches and signs of papilledema. Definitive diagnosis is necessary before surgical treatment. The Queckenstedt test is unreliable, computed tomography is better suited for demonstrating thrombosis of the sagittal sinus rather than the sigmoid sinus, and conventional angiography (although it provides excellent visualization) has the hazard of ionizing radiation and requires vessel puncture and the use of intraarterial contrast agents. We present two cases of thrombosis of the sigmoid sinus as an intracranial otologic complication which were diagnosed definitively with magnetic resonance imaging and magnetic resonance angiography. The combination of magnetic resonance imaging, which showed the thrombosis displaying abnormal signal intensity, and magnetic resonance angiography, which demonstrated the absence of flow in the sinus, was an ideal diagnostic tool. For both patients, treatment consisted of mastoidectomy, sigmoid sinus decompression and antibiotics.

Lateral Sinus Thrombosis Associated With Mastoiditis and Otitis Media in Children

“…The additional use of magnetic resonance venography permits the distinction between slow venous flow and occlusive thrombus, which may be difficult to determine from spin echo MRI sequences. 13 The majority of the patients in our series were diagnosed with MRI/magnetic resonance venography (2 patients were diagnosed by angiography before the routine use of MRI). The neuroradiological diagnosis of venous sinus thrombosis is often challenging given the high frequency of dural venous sinus anatomical variants.…”

“…12 Several authors have advocated for the use of MRI and magnetic resonance venography for increased diagnostic yield. 4,13 MRI not only offers the advantage of imaging in multiple planes but also eliminates the risk of ionizing radiation compared with computed tomography or angiogram, which is particularly helpful in the pediatric population. MRI offers the advantage of simultaneously aiding in the diagnosis of associated mastoiditis and other potential intracranial complications.…”

Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis

“…The presence of OLST was suspected by CT scan in only five cases because the majority of CT scans in emergency situations are performed without contrast enhancement, which significantly reduces the opportunity to detect such a blood flow interruption. Although the gold standard for the diagnosis of OLST remains arteriography, angioresonance imaging (MR angiography) is an interesting non-invasive method that can clearly delineate the patency of central nervous system venous sinuses and can be performed at the same time as the brain MRI study [4,6,7]. In cases of COM with suspected intracranial complications, our image evaluation protocol now includes a CT scan without iodine contrast followed by a cranial MRI with gadolinium enhancement and angio-resonance imaging.…”

“…Some advocate its use [1,7,9,10], while others suggest its inefficiency [4,6,8]. Even those who support anticoagulation recognize that the ideal level of anticoagulation is difficult to achieve and control, and anticoagulation introduces additional risks and prolongs hospitalization.…”

Sigmoid and transverse sinus thrombosis caused by mastoid implant – case report

“…The early detection of this complication by CT and MRI scans allowed early systemic fibrinolytic therapy (Kelly et al, 1991;Magliulo et al, 1996;Davison et al, 1997;Greess et al 2002). Thus, local fibrinolytic therapy (Tsai et al, 1992;PerezDuenas et al, 2002) or thrombectomy (Scarrow et al, 1999;Chow et al, 2000) could be avoided and early rehabilitation with improving neurological symptoms was achieved (Satake et al, 1997).…”