ABSTRACT
PURPOSE: A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signals in the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas of impaired perfusion and to investigate the usefulness of PHSV in predicting prognosis of cerebral infarction. MATERIALS AND METHODS: In 18 patients with acute cerebral infarction who underwent brain MRI with diffusion-weighted imaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacent to areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normal appearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change in the extent of infarction in follow-up images was analyzed. RESULTS: Of the 18 patients, 10 patients showed progression of the infarction, and 8 patients showed little change on follow-up imaging. On SWI, of the 10 patients with progression 9 patients showed peripheral PHSV and the newly developed infarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSV showed progression of the infarct. The patients with infarction progression revealed significantly higher presence of peripheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients with little change. CONCLUSION: SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict the prognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predicting prognosis of acute cerebral infarction.
Subject(s)
Humans , Brain , Cerebral Infarction , Follow-Up Studies , Infarction , Magnetic Resonance Imaging , Perfusion , Prognosis , VeinsABSTRACT
Objective To study MRI manifestations of cerebral developmental venous anomaly (DVA)and to analyze the diagnos-tic value of different sequences.Methods Conventional MRI and contrast enhancement 3D-T1 WI were performed in all 10 patients who were collected in our hospital.Among the 10 cases,6 patients underwent MRA and 4 patients underwent MRV.The diaplay of the draining veins and medullary veins were assessed.Results All 10 cases were sporadic lesion,the lesions of 9 cases were located in supra tentorium and which of 1 case was located in infra tentorium.Abnormal signals without characteristics of draining veins in 6 cases and dilated medullary veins in 4 cases were found in conventional MRI,while 6 draining veins showed flow void signal on T2 WI and 3 of the 4 medullary veins showed hypointensity on T1 WI and hyperintensity on T2 WI.Contrast enhancement 3D-T1 WI displayed the markedly enhanced draining veins and dilated medullary veins in all 10 cases of DVA.Numerous medullary veins gath-ered together into large draining veins radially and flowed into superficial or deeper veins,so-called“caput medusae”appearance were found as the characteristics in all cases.MRA and MRV revealed draining veins only partially but no medullary veins.Conclusion MRI could diagnose DVA clearly,the sensitivity of detecting DVA on conventional MRI is low and there are no characteristics ap-pearances.Contrast enhancement 3D-T1 WI is the most accurate and sensitive method,MRA and MRV are not highly worthwhile for diagnosing DVA.
ABSTRACT
A case of puerperal cerebral hemorrhagic infarction with venous thrombosis in a 36-year-old female is reported. Brain CT scan showed an isodensity area surrounded by ill-defind low density medially in the right frontal lobe, and the most anterior portion of superior sagittal sinus and its draining veins were prominent, but draining veins in the frontal high convexity were not filled in the venous phase of the right carotid angiogram. Osteoplastic craniotomy on the right frontal area was performed to remove the lesion which was mistakenly understood as a mass. Abnormal brain parenchyma was excised from the right frontal subcortical region. Microscopic and pathological evaluation confirmed the diagnosis of hemorrhagic infarction due to venous thrombosis.