CT静脉窦高密度征对不同部位不同阶段颅内静脉窦血栓的诊断意义

Value of dense vein sign on non-contrast enhanced CT of cerebral venous sinus thrombosis in different sites and states

目的评价头颅CT平扫＂高密度征＂对不同部位、不同阶段颅内静脉窦血栓（cerebral venous sinus thrombosis,CVST）的诊断价值。方法收集2006-2013年我院诊断为颅内静脉窦血栓的49例患者的影像资料,入组患者均行颅脑CT平扫、MRI及DSA/MRV/CTV检查。以MRI＋DSA/MRV/CTV作为确定血栓形成部位金标准。统计上矢状窦、左侧横窦和乙状窦、右侧横窦和乙状窦、直窦血栓在不同时间段进行CT平扫时异常＂高密度征＂的阳性率。结果 49例中,经MRI＋DSA/MRV/CTV证实92个静脉窦存在血栓,部位分布为上矢状窦31个,左侧横窦和乙状窦25个,右侧横窦和乙状窦26个,直窦10个。CT＂高密度征＂对上矢状窦、左侧横窦和乙状窦、右侧横窦和乙状窦及直窦血栓的识别阳性率分别为32.3%、40%、42.3%、90%;在发病后≤7 d、8~30 d、〉30 d时行CT检查,＂高密度征＂的阳性率分别为80.8%、37.0%、23.1%。结论头颅CT平扫＂高密度征＂能够识别不同部位静脉窦血栓,对直窦血栓识别率最高。在颅内静脉窦血栓形成≤7 d时,头颅CT平扫通过＂高密度征＂能较敏感地识别大静脉窦部位血栓;病程〉7 d时,头颅CT平扫仍能识别部分CVT,这对于临床上早期识别并诊断CVST具有重要的提示意义。

Objective To evaluate the diagnostic value of dense vein sign on non-contrast enhanced CT of cerebral venous sinus thrombosis （CVST） in different sites and states.Methods Neuroimaging data about 49 patients with CVST who all underwent CT, MRI and DSA/MRV/CTV in our hospital from 2006 to 2013 were collected. Results of MRI and DSA/MRV/CTV were employed as the golden standard to determine thrombosis in superior sagittal sinus, transvers and sigmoid sinus, as well as strait sinus. The positive rate of dense vein sign in different periods after onset of symptoms was analyzed.ResultsOf the 49 patients, thrombosis was detected in 92 major cerebral venous sinus based on MRI＋DSA/MRV/CTV, including 31 in superior sagittal sinuses, 25 in left transverse sinuses and sigmoid sinuses, 26 in right transverse sinuses and sigmoid sinuses, 10 in straight sinuses. The positive rate of dense vein sign in the above thrombosed sinuses was 32.3%, 40%, 42.3%, 90% respectively. And the positive rate of dense vein sign was 80.8% within 7 days, 37.0% between 8 and 30 days and 23.1% after 30 days of symptoms onset.Conclusion Dense vein sign on axial non-contrast enhanced CT can identify venous sinus thrombosis and it is a sensitive feature of thrombosis in major cerebral venous sinus within 7 days while it can be found less frequently after 7 days. Identification of the incidence of dense vein sign on non-contrast enhanced CT is a useful tool in the diagnosis of CVST.