Diagnostic performance of magnetic resonance venography in the detection of recanalization in patients with chronic cerebral venous sinus thrombus

Background In the chronic stage of cerebral venous sinus thrombosis （CVST）, recanalization can result in disparate MR appearances. We aimed to prospectively investigate the diagnostic accuracy of magnetic resonance venography （MRV） in the evaluation of the recanalization of CVST. Methods This study prospectively evaluated the diagnostic performance of 2-dimensional time-of-flight （2D-TOF） MRV in thirty-two consecutive patients during a threeto six-month follow-up for CVST. Both 2D-TOF MRV and digital substraction angiography （DSA） were undertaken. Diagnostic accuracy of 2D-TOF MRV in the detection of recanalized thrombus was evaluated using DSA as the reference standard. Results MRV and DSA were completed without complications in all 32 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of 2D-TOF MRV for the detection of recanalization on a segmental basis were 91% （62/68）, 93% （37/40）, 95% （62/65）, and 86% （37/43） respectively. Conclusion 2D-TOF MRV provides high sensitivity and specificity for the diagnosis of recanalized CVST segments.

Review of imaging and endovascular intervention of iliocaval venous compression syndrome

Iliocaval venous compression syndrome(ICS)is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra.Chronic compression can lead to venous stenosis and stasis,which manifests as chronic venous disease and treatment resistance.Therefore,early recognition of ICS and prompt treatment are essential.Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies.The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass,which is followed by computed tomography(CT)or magnetic resonance(MR)venography.CT and MRI can identify the anatomical causes for venous compression.In patients with high clinical suspicion for ICS,negative findings on CT and MR venography would still warrant further investigations.Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality.In this review paper,we will discuss the evidence,utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.