Role of Magnetic Resonance Venography, Diffusion-Weighted Imaging, and Gradient-Recalled Echo in Cerebral Sinovenous Thrombosis
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 5
Abstract
Background: Cerebral venous thrombosis (CVT) is a cause of stroke with inconspicuous pathophysiological properties that differ from arterial stroke. It is an elusive diagnosis because of its non-specific presentation and its subtle imaging findings. Diagnosis is often missed on initial imaging. Patients with CVT often make dramatic recoveries after effective therapies including anticoagulants and intrasinus thrombolysis. Accurate diagnosis is difficult as conventional magnetic resonance imaging (MRI) which cannot differentiate between cytotoxic and vasogenic edema. The use of magnetic resonance venography (MRV), diffusion-weighted imaging (DWI), and gradient echo (GRE) combines the strengths of individual imaging sequences in improving diagnostic yield. Accurate and timely imaging diagnosis is essential because it facilitates patient triage, guides clinical management, and helps determine patient prognosis. Diffusion-weighted MRI (DWI) has been reported to detect early ischemic damage (cytotoxic edema) as bright high-signal intensity (SI) and vasogenic edema as heterogeneous SI. Aim: The aim of this study was as follows: (1) To study the extent of venous sinus involvement and associated cerebral parenchymal changes on MRV, (2) to study the pattern of diffusion-weighted images and apparent diffusion coefficient (ADC) mapping in patients with CVT, (3) to study the role of GRE in patients with CVT, and (4) to characterize the clinical applications of DWI in CVT. Methods: A study was conducted on 20 patients diagnosed to have CVT on imaging, over the period of 6 months. Results: Imaging analyses of 20 patients (9 males, 11 females, and age range 19–65 years) were done. Thrombus on MRV was seen as loss of high-flow signal from the sinus in cases of total occlusion of the sinus and frayed or patchy flow signal in the cases of non-occlusive thrombus. 10 patients with hemorrhagic infarct showed heterogeneous SI on DWI and blooming on GRE sequence. Five patients with non-hemorrhagic infarct showed multifocal high-signal intensities in DWI with variable ADC values and no blooming on GRE sequence. Two patients with intracerebral hematoma showed areas of heterogeneous signals on DWI with blooming on GRE sequence, corresponding ADC values were variable. Two patients with no parenchymal changes and one patient with chronic venous thrombosis presented with benign intracranial hypertension. Conclusions: MRV, DWI, and GRE can be used to evaluate the extent of thrombus, differentiate between types of edema, detect intracerebral hematoma, hemorrhagic and non-hemorrhagic infarcts, and give time-saving information for early diagnosis of CVT.
Authors and Affiliations
Nadeem Ahmed, Alle Praveen Kumar, Swapna Chouhan, Shaik Ismail, Uzma Afreen
Keywords
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