脑静脉窦血栓形成的综合影像诊断

Comprehensive Imaging Diagnosis of Cerebral Venous Sinus Thrombosis

目的评价脑静脉窦血栓形成的影像综合检查与诊断价值。方法回顾性分析18例脑静脉窦血栓形成(CVST)患者的综合影像资料,18例均行常规CT和MRI平扫,6例行减影法多层螺旋CT脑静脉成像(MSCTV),13例行磁共振对比增强三维脑静脉减影法成像(3D CE-MRV),12例行数字减影血管造影(DSA)检查。结果 18例CVST患者中,经影像学检查发现上矢状窦CVST8例,横窦2例,乙状窦4例,直窦2例,上矢状窦及乙状窦均受累2例。6例(33.3%)CT平扫可提供重要的影像表现,尤其是MSCTV更为直观。18例CVST患者MRI检查均可清晰显示脑静脉窦血栓形成导致的流空效应消失,静脉窦内出现各期血栓的不同信号,13例可见脑水肿、脑梗死、脑出血等间接征象。15例3DCE-MRV检查均发现CVST的血栓征象(静脉窦充盈缺损或中断)。12例行DSA检查均能获得明确诊断。结论影像综合检查对CVST的早期发现、确诊及制订治疗方案具有重要价值。

Objective To evaluate the value of combined imaging examinations in diagnosis of cerebral venous sinus thrombosis（CVST）. Methods Retrospective analysis of 18 CVST patients with CT,MRI,Multi-slice CT venography （MSCTV） ,three-dimensional contrast-enhanced MR venography （3D CE-MRV） and DSA imaging data. 18 cases of CVST were examined with CT and MRI,6 cases were examined with MSCTV,15 cases were examined with 3D CE-MRV,and 12 cases were examined with digital subtraction angiography（DSA）. Results Among the 18 CVST cases,the superior sagittal sinus was involved in 8 cases,the transverse sinus in 2 cases,the sigmoid sinus in 4 cases,the straight sinus in 2 cases,and both the superi or sagittal and sigmoid sinus in the other 2 cases. CT examination could provide important clues for the early diagnosis of CVST ,especially MSCTV,but with low positive rate（33.3%）. Direct signs of 18 CVST thrombosis could be displayed by MRI,showing disappearance of flow void effect of venous sinus,various signal intensities within CVST assessed in different stages of thrombosis. Indirect signs of 13 CVST thrombosis included cerebral edema,cerebral infarction and cerebral hemorrhage etc. Filling defect or interruption of venous sinus was found by 3D CE-MRV in all the 15 patients receiving this scan. The 12 patients were diagnosed correctly using DSA. Conclusion The combined imaging examinations has important value for the discovery,diagnosis and treatment of the CVST.