上矢状窦和乙状窦血栓形成的临床和磁共振诊断七例报告

Clinical features and MR imaging for the diagnoses of 7 cases of superior sagittal and sigmoid sinus thrombosis

目的分析上矢状窦、乙状窦血栓形成的临床特点、形成原因、磁共振成像及磁共振血管造影对其诊断的价值。方法回顾性分析７例经磁共振检查确诊的硬脑膜静脉窦血栓形成病人的临床资料及影像学特点，其中男２例，女５例，年龄１５～３４岁。病后３～１１天行磁共振检查，主要观察水肿、静脉性梗死或出血、硬脑膜异常强化及静脉窦内异常信号，部分病人复查时可观察到再通。结果硬脑膜静脉窦血栓形成７例皆有明确原因，临床表现多样，主要为亚急性颅内压增高、抽搐、肢体瘫痪或昏迷。ＭＲＩ常规ＳＥ序列Ｔ１、Ｔ２加权示窦内高信号，脑实质水肿或合并出血、梗死，强化后显示闭塞静脉窦附近硬脑膜异常强化；磁共振脑血管造影（ＭＲＡ）的ＰＣ法示静脉窦高血流信号丢失，２例分别于病后２９及３７天复查ＭＲＩ，结果显示再通，硬脑膜异常强化消失。经降颅内压、抗凝，合并炎症者给予抗生素、激素治疗，１例外伤引起者经手术治疗，７例均治愈。结论硬脑膜静脉窦血栓形成是较为少见的脑血管病，且病情重，ＭＲＩ／ＭＲＡ可帮助确诊。早期治疗可明显改善预后。

Objective To analyze the clinical features and MR imaging for the diagnoses of 7 cases of superior sagittal and sigmoid sinus thrombosis. Methods 7 cases of sagittal and sigmoid thrombosis with MR imaging (MRI) and/or MR angiography (MRA) examinations were retrospectively reviewed. There were 2 males and 5 females, their ages being 15～34 years old. The examinations were performed 3～11 day after the onsets of the disease, observing the cerebral swelling , venous infarction or hemorrhage, abnormal enhancement of the dura mater and abnormal signals of the thrombosed sinuses. 2 cases were followed up with MRI 29 and 37 days respectively after the onsets of the disease. Results The causes of the disorder varied evidently. The 7 patients manifested themselves clinically in various manners with subacute intracranial hypertension, seizures, limb palsies or coma. The MRI with routine SE sequence T 1 ,T 2 weighted showed high intensity signals inside the thrombosed sinuses, cerebral edema, hemorrhage or infarction and abnormal enhancement of the dura mater with gadolinium injection. The MRA with PC technique showed loss of plane signals of the thrombosed sinuses. In 2 cases follow up was performed 29 and 37days after the onsets of the disease with the MRI indicating recanalization. Six patients were treated with the dehydrant and anticoagulant, when the associated infection was treated with antibiotics and adreno cortical hormone, and one patient was treated with surgical operation. All recovered well. Conclusions Dural venous sinus thrombosis(DVST) has been an uncommon and serious condition and can be diagnosed with MR imaging and MR angiography. If such patients can be diagnosed and treated early, good recovery improlement can often be achieved.