J Korean Soc Radiol.  2018 May;78(5):330-339. 10.3348/jksr.2018.78.5.330.

Comparison of MRI Sequences for the Detection of Cerebral Venous Sinus Thrombosis During Follow-Up Examination

• Choi JE
• Weon YC
• Park GM
• Kwon JH
• Kim WJ
• Kwon WJ
• Choi SH

• KMID: 2410722
• DOI: http://doi.org/10.3348/jksr.2018.78.5.330

Abstract

PURPOSE
To compare the diagnostic performance of magnetic resonance (MR) sequences for the evaluation of cerebral venous sinus thrombosis (CVST) during follow-up examinations.
MATERIALS AND METHODS
Thirteen cases that were confirmed to be CVST between January 2006 and March 2016 were included in this study. Two neuroradiologists independently examined each initial and follow-up MR sequence image in random order.
RESULTS
Gadolinium-enhanced T1-weighted imaging (Gd-enhanced T1WI) was the most sensitive sequence for the detection of CVST in the initial and follow-up MR examinations (82% and 55.3%, respectively). Among the non-enhanced MR sequences of the initial examination, gradient-recalled echo was the most sensitive (77.4%), fluid-attenuated inversion recovery (FLAIR) had low sensitivity (34.4%). The overall diagnostic performances of all MR sequences except for FLAIR decreased during the follow-up. FLAIR was the most sensitive during follow-up, and was also the only sequence with increased sensitivity during follow-up (from 34.4% to 55.6%).
CONCLUSION
Gd-enhanced T1WI had the best diagnostic performance for CVST in both initial and follow-up MR examinations. Therefore, it is reasonable to use Gd-enhanced T1WI to evaluate CVST during follow-up examinations. However, for patients who cannot tolerate MR contrast agents, the use of FLAIR to assess the remaining CVST during the follow-up may be helpful.

MeSH Terms

Contrast Media
Diagnosis
Follow-Up Studies*
Humans
Intracranial Thrombosis
Magnetic Resonance Imaging*
Sinus Thrombosis, Intracranial*
Contrast Media

Figure

• 

  Fig. 1. Study flow chart. AVF = arteriovenous fistula, CVT = cerebral venous thrombosis, DWI = diffusion-weighted imaging, FLAIR = fluid-attenuated inversion recovery, GRE = gradient-recalled echo, MRV = magnetic resonance venography

• 

  Fig. 2. Images of a 51-year-old man with acute left transverse sinus thrombosis (3 days). Note the susceptibility artifact, which is low signal and blooming (white arrows) on gradient-recalled echo imaging (A) and the empty delta sign (black arrows) in the left transverse sinus on Gd-enhanced T1-weighted imaging (B). No signal change is observed in the left transverse sinus (black arrows) compared to the normal right transverse sinus on fluid-attenuated inversion recovery (C). No diffusion restriction is observed in the left transverse sinus (white arrows) on diffusion-weighted imaging (D). Dural venous sinus thrombosis is confirmed as the filling defect in left transverse and sigmoid sinuses on gadolinium-enhanced 4 dimensional magnetic resonance venography (E).

• 

  Fig. 2. (continued) Images of a 51-year-old man with left transverse sinus thrombosis during follow-up (12 days). The patient underwent followup brain magnetic resonance imaging including MRV 12 days after the first examination due to aggravation of the headache. Note the susceptibility artifact on gradient-recalled echo (F) and typical empty delta sign in the left transverse sinus on Gd-enhanced gadolinium-enhanced T1-weighted imaging (G) are not observed (black arrows). The high signal intensity (black arrows) on fluid-attenuated inversion recovery (H), and high signal intensity indicating diffusion restriction (black arrows) in the left transverse sinus on diffusion-weighted imaging (I). Dural venous sinus thrombosis is confirmed as the filling defect in the left transverse and sigmoid sinuses on follow-up gadolinium-enhanced 4 dimensional MRV (J). MRV = magnetic resonance venography

Reference

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