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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 noncontrast computed-tomography scan revealed A,B,C) hyperdense of cord sign in left cortical vein with noncontrast filling in post contrast enhanced study. Hemorrhagic spot in left parietal lobe is noted (arrow). Magnetic resonance imaging shows D,E,F) hyposignal T1W, T2W_FFE (shows blooming susceptibility effct (arrow) of hemorrhage in left parietal lobe. Post contrast enhanced MR venography showed G,H,I) a small filling defect at superior sagittal sinus (seen on 3D_T1W/Gd) and lacking of cortical vein of left high parietal region corresponding with CT imaging, compatible with cerebral venous thrombosis.
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Figure 9: Axial noncontrast computed-tomography scan revealed A,B,C) hyperdense of cord sign in left cortical vein with noncontrast filling in post contrast enhanced study. Hemorrhagic spot in left parietal lobe is noted (arrow). Magnetic resonance imaging shows D,E,F) hyposignal T1W, T2W_FFE (shows blooming susceptibility effct (arrow) of hemorrhage in left parietal lobe. Post contrast enhanced MR venography showed G,H,I) a small filling defect at superior sagittal sinus (seen on 3D_T1W/Gd) and lacking of cortical vein of left high parietal region corresponding with CT imaging, compatible with cerebral venous thrombosis.

Mentions: MRI combined (Figure 9) with MR venography (MRV) has largely replaced invasive cerebral angiography and conventional CT.2 CT is entirely normal in 10–20% of cases with proven CVT. MRV in conjunction with conventional MRI can accurately diagnose CVT and is reliable as the sole examination for this condition. MRV is currently considered to be the noninvasive test of choice for evaluation of the dural sinus. However, flow-related and susceptibility artifacts can impair the evaluation of the venous structures. The more invasive arterial DSA is still the standard of reference.2 MRV may be performed without the use of a contrast agent using the time-of-flight (TOF) technique or the phase contrast technique. Because these techniques use MR flow phenomena for contrast generation, they are subject to flow-related image artifacts. Similar to CTV, contrast-enhanced MRV (Figure 8D,E,F,G,H) takes advantage of luminal filling by contrast material rather than relying on the MR flow phenomena as in TOF or phase contrast MRV. Therefore, contrast-enhanced MRV is less likely to be affected by complex flow. Recently, gadolinium-enhanced MRV has been shown to be superior to TOF MRV and may offer the best evaluation using MRI.12 In Meckel et al study, compare with MR and MRV sequences for the diagnostic accuracy of a combined dynamic and static contrast-enhanced MRV in CVT, found that combo-4D MRV demonstrated the highest overall sensitivity (binary test) among the 4 assessed techniques, T2w, GRE, TOF, 4D-MRV.18 In dural venous sinus thrombosis alone, it showed the highest sensitivity (97%) and specificity (99%).18


Cerebral venous thrombosis: diagnosis dilemma.

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

Axial noncontrast computed-tomography scan revealed A,B,C) hyperdense of cord sign in left cortical vein with noncontrast filling in post contrast enhanced study. Hemorrhagic spot in left parietal lobe is noted (arrow). Magnetic resonance imaging shows D,E,F) hyposignal T1W, T2W_FFE (shows blooming susceptibility effct (arrow) of hemorrhage in left parietal lobe. Post contrast enhanced MR venography showed G,H,I) a small filling defect at superior sagittal sinus (seen on 3D_T1W/Gd) and lacking of cortical vein of left high parietal region corresponding with CT imaging, compatible with cerebral venous thrombosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Axial noncontrast computed-tomography scan revealed A,B,C) hyperdense of cord sign in left cortical vein with noncontrast filling in post contrast enhanced study. Hemorrhagic spot in left parietal lobe is noted (arrow). Magnetic resonance imaging shows D,E,F) hyposignal T1W, T2W_FFE (shows blooming susceptibility effct (arrow) of hemorrhage in left parietal lobe. Post contrast enhanced MR venography showed G,H,I) a small filling defect at superior sagittal sinus (seen on 3D_T1W/Gd) and lacking of cortical vein of left high parietal region corresponding with CT imaging, compatible with cerebral venous thrombosis.
Mentions: MRI combined (Figure 9) with MR venography (MRV) has largely replaced invasive cerebral angiography and conventional CT.2 CT is entirely normal in 10–20% of cases with proven CVT. MRV in conjunction with conventional MRI can accurately diagnose CVT and is reliable as the sole examination for this condition. MRV is currently considered to be the noninvasive test of choice for evaluation of the dural sinus. However, flow-related and susceptibility artifacts can impair the evaluation of the venous structures. The more invasive arterial DSA is still the standard of reference.2 MRV may be performed without the use of a contrast agent using the time-of-flight (TOF) technique or the phase contrast technique. Because these techniques use MR flow phenomena for contrast generation, they are subject to flow-related image artifacts. Similar to CTV, contrast-enhanced MRV (Figure 8D,E,F,G,H) takes advantage of luminal filling by contrast material rather than relying on the MR flow phenomena as in TOF or phase contrast MRV. Therefore, contrast-enhanced MRV is less likely to be affected by complex flow. Recently, gadolinium-enhanced MRV has been shown to be superior to TOF MRV and may offer the best evaluation using MRI.12 In Meckel et al study, compare with MR and MRV sequences for the diagnostic accuracy of a combined dynamic and static contrast-enhanced MRV in CVT, found that combo-4D MRV demonstrated the highest overall sensitivity (binary test) among the 4 assessed techniques, T2w, GRE, TOF, 4D-MRV.18 In dural venous sinus thrombosis alone, it showed the highest sensitivity (97%) and specificity (99%).18

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