联合不同影像技术对脑静脉窦血栓的诊断分析评价

Analysis and Evaluation of Cerebral Venous Sinus Thrombosis with Combined Imaging Techniques

目的分析35例脑静脉窦血栓患者的临床资料及CT、MRI影像学特征,结合文献复习,旨在提高对脑静脉窦血栓的认识,从而早期诊断指导临床及时治疗。方法回顾性分析静脉窦血栓患者的病史,结合患者的临床表现、发病起因,对常规头颅CT及MRI平扫、增强扫描、磁共振静脉血管成像、磁敏感加权成像表现进行系统的归纳分析,总结静脉窦血栓的影像学特征。结果 35例脑静脉窦血栓患者共45处血栓形成,其中上矢状窦血栓形成17处(37.8%),左侧横窦血栓形成6处(13.3%),右侧横窦血栓形成8处(17.8%),左侧乙状窦血栓形成4处(8.9%),右侧乙状窦血栓形成5处(11.1%),直窦血栓形成5处(11.1%)。28例可观察到血栓的直接征象,间接征象包括静脉淤血性脑梗死(24例),出血(8例),磁敏感加权成像上较其他序列更易发现脑内出血灶,磁共振静脉血管成像可见皮层浅静脉增粗、增多;增强扫描可见静脉窦血栓处呈"空三角征"。结论联合应用不同的影像技术可提高对脑静脉窦血栓诊断的准确性,从而指导脑静脉窦血栓的早期诊断及早期治疗,减少病死率、病残率及后遗症的发生。

Objective To analyze the clinical data and CT,MRI imaging features of 35 patients with cerebral venous sinus thrombosis,aimed at raising awareness of cerebral venous sinus thrombosis（ CVST） so that early diagnosis and timely clinical treatment can be achieved. Methods A retrospective analysis was done for the CVST patients,their medical history,clinical manifestations,the incidence of the causes,and imaging manifestations including conventional CT,MRI,enhanced scans,MRV,SWI were systematically summarized and analyzed. Results 35 patients with cerebral venous sinus thrombosis had a total of 45 thromboses,in which 17 cases（ 37. 78%） were of sagittal sinus thrombosis,6 cases（ 13. 33%） of left transverse sinus thrombosis,8 cases（ 17. 78%） of right transverse sinus thrombosis,4 cases（ 8. 89%）of left sigmoid sinus thrombosis,5 cases（ 11. 11%） of right sigmoid sinus thrombosis and 5 cases（ 11. 11%） of straight sinus thrombosis. Direct signs of thrombosis could be observed in 28 cases,indirect signs include cerebral infarction（ 24 cases）,hemorrhage（ 8 cases）,SWI sequence can easily identify the bleeding,while superficial cortical vein thickening and growth in size were seen in MRV. Venous sinus thrombosis manifested as ＂ empty triangle/delta sign＂ in enhanced CT/MRI scan. Conclusion Combined imaging techniques can improve the accurate diagnosis of cerebral venous sinus thrombosis,which can guide early diagnosis and early treatment,and to reduce the mortality,morbidity and the sequelae.