脑静脉窦血栓形成的影像学特征与早期诊断

Neuroimaging characteristics and early diagnosis of cerebral venous sinus thrombosis

目的 探讨脑静脉窦血栓形成 (CVT)的早期临床和影像学特点 ,以利于 CVT的早期诊断。方法 回顾性分析 4 2例确诊的、有完整影像学资料的 CVT患者的临床表现和颅脑 CT、MR、数字减影血管造影 (DSA)结果。结果 4 2例 CVT患者早期的常见症状有头痛 (10 0 % )、局灶性神经功能缺损 (6 7% )和癫痫发作 (5 7% ) ,多被误诊为动脉性脑梗死、脑内占位或脑炎。影像学上 39例可见静脉性脑梗死特征 (引流区域脑实质肿胀和出血性梗死 ) ,2 3例颅脑 MR上可见 T2 WI病灶远大于弥散加权项 (DWI)上的病灶 ,且坏死灶多仅位于皮层 (87% )。T2 WI上脑静脉窦流空信号消失有确诊价值 ,对上矢状窦血栓 (96 % )较侧窦血栓更敏感 (5 0 % )。DSA显示相应的静脉窦闭塞及静脉侧支循环 ,脑动静脉循环时间延长。结论 头痛、癫痫发作和局灶性神经功能缺损是 CVT早期的常见症状 ,但缺乏特征性。熟识影像学上静脉性脑梗死的特征性表现 (脑实质肿胀明显 ,但坏死轻微且常常伴有出血 ) ,对 CVT的早期诊断至关重要 ,颅脑 MR上 T2 WI上脑静脉窦流空信号消失有确诊价值。对于 MR无法确诊的病例 ,颅脑磁共振静脉血管造影 (MRV)或 DSA可明确诊断。 CVT病灶功能障碍区域大而坏死轻微时 。

Objective To study the neuroimaging characteristics and clinical manifestations of cerebral venous sinus thrombosis(CVT)to make an early diagnosis.Methods Clinical manifestations and neuroimaging findings were analyzed retrospectively in 42 CVT patients.Results The common symptoms of these 42 cases included headache(100%),focal deficits(67%)and seizures(57%),they were often misdiagnosised as arterial infarction,tumor or encephalitis.Neuroimaging findings suggested venous infarction in 39 cases,which characterized by severe parenchymal edema and hemorrhagic infarcts.The lesions were much larger in T 2WI than in DWI in 23 patients,and most necrotic lesions(87%)located in the gray matter.Lost of flowing void effect on T 2WI could confirm the diagnosis,and it was more sensitive for superior sagital sinus(SSS)thrombosis than for lateral sinus thrombosis(96% vs.50%).Digital subtracted angiography(DSA)showed occluded sinus and lateral circulation,and cerebral arteriovenous circulation time delayed.Conclusions Headache,seizures and focal deficits are common but not specific symptoms of CVT.To be familiar with the neuroimaging findings are essential for its early diagnosis.Lost of flowing avoid effect on T 2WI can confirm the diagnosis,DSA is the gold standard.The necrotic area is smaller,the prognosis maybe better.