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Cerebral venous thrombosis: diagnosis dilemma.

Chiewvit P, Piyapittayanan S, Poungvarin N - Neurol Int (2011)

Bottom Line: This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice.Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment.By using of effective treatment will improve the prognosis of the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Division of Diagnostic Radiology.

ABSTRACT
Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.

No MeSH data available.


Related in: MedlinePlus

Axial T1W, T2W and FLAIR demonstrate A,B,C) intermediate signal intensity T1W and hyposignal intensity T2W (acute thrombus) and high signal intensity of thrombus in FLAIR. Post gadolinium contrast study revealed D,E,F,G,H) empty delta sign (arrow) and tentorial dural enhancement (arrowhead).
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Figure 8: Axial T1W, T2W and FLAIR demonstrate A,B,C) intermediate signal intensity T1W and hyposignal intensity T2W (acute thrombus) and high signal intensity of thrombus in FLAIR. Post gadolinium contrast study revealed D,E,F,G,H) empty delta sign (arrow) and tentorial dural enhancement (arrowhead).

Mentions: Magnetic resonance imaging (MRI) with MR venography (Figure 8A–8H) has become the investigation of choice in diagnosis of CVT. MRI is more sensitive in picking up the thrombus, and demonstrates age dependant signal characteristics.3 One of the most important findings on MRI is abnormal signal intensity within the venous structure, indicating altered flow and thrombus formation. Gradient recalled-echo (GRE) T2*WI is becoming more widely used as a standard MR pulse sequence because of its sensitivity to acute intracranial hemorrhage. The signal intensity of CVT and normal flow states can both be variable, leading to diagnostic confusion.12 Acute stage thrombus (within the first 7 days after clinical symptoms) has been shown to exhibit very subtle signal intensity alterations on noncontrast MR that can be mimic a normal flow void on T2WI.4,12 One of the major reasons for the variable appearances of venous thrombus is thought to be alterations in hemoglobin oxygenation and iron oxidation state within trapped red-blood cells or extracellularly within the thrombus itself.12 In the acute stage, thrombus is usually isointense on T1WI and hypointense on T2WI (Figure 8A,B) and relates to paramagnetic deoxyhemoglobin within trapped red blood cells within the thrombus. However, by using of T2W_FLAIR as conventional sequence is also helpful in detection of acute thrombus. This will be high signal intensity in T2W_FLAIR sequence.17 In the subacute phase (7–14 days) divided into early and late subacute phase. Thrombus signal intensity of early subacute phase appeared hypersignal intensity on T1WI, and hyposignal intensity on T2WI, relating to intracellular methemoglobin. A late subacute phase can occur relating to extracellular methemoglobin in the evolving hyalinizing thrombus, where there is hypersignal intensity on both T1WI and T2WI. In the chronic stage (greater than 15 days), signal intensity is typically isointense on T1WI and hyperintense on T2WI and is probably related to the vascularized connective tissue of chronic thrombus.11 There has been recent interest in evaluating the appearance of intraluminal venous thrombi on DWI. Signal hyperintensity in thrombosed sinuses on diffusion weighted images, with corresponding diminishment in the mean apparent diffusion coefficient (ADC) values, has been described in 41% of patients with sinus thrombosis. The duration of clinical symptoms was longer and complete recanalization was less frequent in patients with restricted diffusion in the thrombus.8


Cerebral venous thrombosis: diagnosis dilemma.

Chiewvit P, Piyapittayanan S, Poungvarin N - Neurol Int (2011)

Axial T1W, T2W and FLAIR demonstrate A,B,C) intermediate signal intensity T1W and hyposignal intensity T2W (acute thrombus) and high signal intensity of thrombus in FLAIR. Post gadolinium contrast study revealed D,E,F,G,H) empty delta sign (arrow) and tentorial dural enhancement (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3286153&req=5

Figure 8: Axial T1W, T2W and FLAIR demonstrate A,B,C) intermediate signal intensity T1W and hyposignal intensity T2W (acute thrombus) and high signal intensity of thrombus in FLAIR. Post gadolinium contrast study revealed D,E,F,G,H) empty delta sign (arrow) and tentorial dural enhancement (arrowhead).
Mentions: Magnetic resonance imaging (MRI) with MR venography (Figure 8A–8H) has become the investigation of choice in diagnosis of CVT. MRI is more sensitive in picking up the thrombus, and demonstrates age dependant signal characteristics.3 One of the most important findings on MRI is abnormal signal intensity within the venous structure, indicating altered flow and thrombus formation. Gradient recalled-echo (GRE) T2*WI is becoming more widely used as a standard MR pulse sequence because of its sensitivity to acute intracranial hemorrhage. The signal intensity of CVT and normal flow states can both be variable, leading to diagnostic confusion.12 Acute stage thrombus (within the first 7 days after clinical symptoms) has been shown to exhibit very subtle signal intensity alterations on noncontrast MR that can be mimic a normal flow void on T2WI.4,12 One of the major reasons for the variable appearances of venous thrombus is thought to be alterations in hemoglobin oxygenation and iron oxidation state within trapped red-blood cells or extracellularly within the thrombus itself.12 In the acute stage, thrombus is usually isointense on T1WI and hypointense on T2WI (Figure 8A,B) and relates to paramagnetic deoxyhemoglobin within trapped red blood cells within the thrombus. However, by using of T2W_FLAIR as conventional sequence is also helpful in detection of acute thrombus. This will be high signal intensity in T2W_FLAIR sequence.17 In the subacute phase (7–14 days) divided into early and late subacute phase. Thrombus signal intensity of early subacute phase appeared hypersignal intensity on T1WI, and hyposignal intensity on T2WI, relating to intracellular methemoglobin. A late subacute phase can occur relating to extracellular methemoglobin in the evolving hyalinizing thrombus, where there is hypersignal intensity on both T1WI and T2WI. In the chronic stage (greater than 15 days), signal intensity is typically isointense on T1WI and hyperintense on T2WI and is probably related to the vascularized connective tissue of chronic thrombus.11 There has been recent interest in evaluating the appearance of intraluminal venous thrombi on DWI. Signal hyperintensity in thrombosed sinuses on diffusion weighted images, with corresponding diminishment in the mean apparent diffusion coefficient (ADC) values, has been described in 41% of patients with sinus thrombosis. The duration of clinical symptoms was longer and complete recanalization was less frequent in patients with restricted diffusion in the thrombus.8

Bottom Line: This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice.Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment.By using of effective treatment will improve the prognosis of the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Division of Diagnostic Radiology.

ABSTRACT
Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.

No MeSH data available.


Related in: MedlinePlus