脑静脉与静脉窦血栓形成累及的结构及其影像学特征研究

Study on the involved structures and imaging manifestations of cerebral vein and sinus thrombosis

目的探讨脑静脉及静脉窦血栓形成(CVST)累及的结构及影像学特征。方法回顾性分析152例经临床及影像检查确诊为CVST患者的临床资料,观察CVST累及的结构,分析其影像学特征。结果152例CVST中,最常受累的静脉结构为横窦(57.2%),其次为上矢状窦(51.9%)、乙状窦(48%)、颈内静脉(12.5%),超过50%的CVST累及多个静脉窦,皮质静脉及深静脉血栓少见;上矢状窦血栓以中段血栓最为常见。39.5%的患者存在脑实质损害,最为常见的是脑水肿或脑肿胀,其次是静脉性脑梗死、颅内出血等;CVST最为常见的CT影像学特征依次是高密度三角征、条带征,而高密度点征、火焰征少见;MRI的特征性表现为静脉血管腔血液流空效应消失;DSA表现为静脉窦腔狭窄、显影变淡或完全不显影,侧支静脉异常扩张。结论CVST主要累及横窦及上矢状窦中段,常同时阻塞多个静脉窦;常见的直接影像学特征有条带征、三角征及血管充盈缺损;间接影像征象有脑水肿、脑出血、静脉性脑梗死等。了解脑静脉及静脉窦的结构及CVST影像学特征对CVST的早期诊断具有重要意义。

Objective To explore the involved structures and imaging manifestations of cerebral vein and sinus thrombosis(CVST).Methods Clinical data of 152 patients diagnosed as CVST by clinical and imaging examinations were analyzed retrospectively,CVST involved structures were observed and the imaging manifestations were analyzed.Results The most common involved structures of CVST was the lateral sinus(57.2%),followed by the superior sagittal sinus(51.9%),sigmoid sinus(48%)and internal jugular vein(12.5%).Multiple sinuses were involved over 50%of cases,cortical venous thrombosis and cerebral deep vein thrombosis were uncommon;the superior sagittal sinus thrombosis was the most common in the middle segment.About 39.5%of CVST patients had brain parenchymal damage,the most common damage was cerebral edema or brain swelling,followed by cerebral venous infarction and intracranial hemorrhage.High density triangle sign and cord sign were the most common CT imaging manifestations of CVST,but high density pot sign and flame sign were rare.The MRI imaging manifestations of CVST were the disappearance of a flow void of blood in the venous vascular cavity;DSA was manifested as venous cavity stenosis,fading or no visualization,and abnormal expansion of collateral veins.Conclusion CVST is mainly involved lateral sinus and the middle segment of the superior sagittal sinus,and often involved multiple venous sinuses;common direct imaging findings include cord sign,triangle sign and vascular filling defects;and indirect signs include cerebral edema,hemorrhage,cerebral venous infarction.It is of great significance for the early diagnosis of CVST to understand the structures and imaging manifestations of cerebral vein and venous sinus and the imaging manifestations of CVST.