颅内静脉窦血栓形成患者静脉窦MRI强化特征研究

Role of enhancement features of cerebral venous sinus in the diagnosis of cerebral venous sinus thrombosis： a MRI study

目的 观察血栓形成的静脉窦在增强MRI的强化表现,评价静脉窦＆quot;周边线样强化＆quot;对相应部位颅内静脉窦血栓形成（cerebral venous sinus thrombosis,CVST）诊断的敏感度和特异度.方法 以2005年1月至2014年12月我院神经内科收治的CVST并接受了增强MRI扫描的45例患者为研究对象.在与感兴趣静脉窦平行的层面确定上矢状窦、直窦、左横窦、右横窦和左乙状窦、右乙状窦的MRI强化表现,将静脉窦的强化特征分为周边线样强化、部分强化和完全强化3种类型,对比3种强化表现在血栓形成的静脉窦和正常静脉窦组内和组间分布有无差异,计算周边线样强化这一影像表现诊断相应部位静脉窦血栓形成的敏感度和特异度,并对比3种强化表现在发病后急性期（≤7 d）、亚急性期（8 ～30 d）和慢性期（≥31 d）增强MRI的分布有无差异.结果 周边线样强化、部分强化和完全强化在血栓形成的静脉窦和正常静脉窦均可出现.3种强化类型的出现率在正常上矢状窦[100％ （30/30）和60％ （27/45）,x2=13.789,P=0.001]、左侧横窦、右侧乙状窦与血栓组之间差异有统计学意义.周边线样强化在诊断相应部位静脉窦血栓形成的敏感度为10.5％ ～44.4％,特异度为53.3％ ～76.7％.在发病后不同时期的强化MRI,3种强化类型的分布差异无统计学意义.结论 在增强MRI中,静脉窦周边的线样强化这一影像表现诊断CVST的敏感度和特异度均较低,将“空δ征”作为CVST影像证据的观点值得商榷.

Objective To describe the changes of thrombosed venous sinus on MRI after administration of contrast material and evaluate the sensitivity and specificity of ＂thread-like enhancement around sinus＂ to diagnose thrombosis in the corresponding sinus.Methods Patients with cerebral venous sinus thrombosis （CVST） admitted to our department from January 2005 to December 2014 and undergone a MRI scan with administration of contrast material were included in this study.The enhancement features of venous sinus were studied in the plane parallel to the interested sinus.The features of enhancement were classified as peripheral thread-like enhancement, partial enhancement and complete enhancement.The proportion of these three type of enhancement in thrombosed sinuses and normal sinuses were described and compared.The sensitivity and specificity of ＂peripheral thread-like enhancement＂ to diagnose thrombosis in corresponding sinus were calculated.The proportion of each type of enhancement was also described and compared in acute （≤ 7 d）, subacute （8-30 d） and chronic （≥ 31 d） stage after onset of symptoms.Results Peripheral thread-like enhancement, partial enhancement and complete enhancement were all found in both thrombosed and normal sinuses.There was a significant difference of enhancement features between normal and thrombosed sinus in superior sagittal sinus （100% （30/30） vs 60% （27/45）, x2 =13.789, P =0.001）, left trans verse sinus, and right sigrnoid sinus.The sensitivity and specificity of＂peripheral thread-like enhancement＂ to diagnose thrombosis in the corresponding sinus were 10.5%-44.4% and 53.3%-76.7% respectively.There was no significant difference of contrast features at different stage after onset.Conclusion The value of ＂peripheral thread-like enhancement＂ to diagnose CVST is limited because of low sensitivity and specificity.