A study of clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men

Cerebral sinus venous thrombosis (CSVT) is very rare in men compared to women. There are many causes but they are very rare in men, and it is an uncommon cause of cerebral infarction. Patients usually present with Headache, Focal deficits such as Monoparesis, Hemiparesis, Paraparesis and Hemisensory disturbances, seizures, impairment of level of consciousness. Now it is recognized as a non-septic disorder with various clinical presentations with a favorable outcome, and low mortality rate below. CT scan, MRI and Magnetic Resonance Venography (MRV) are the best diagnostic methods for diagnosis and low molecular weight heparin is the first-line treatment. Results of this study, clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men are discussed.

Intracranial Magnetic Resonance Venography of Superior Sagittal Sinus, Straight Sinus and Cerebral Venous Channels: Normal Anatomy and Variations in North Indian Population

The intracranial dural venous sinuses can be injured leading to thrombosis with in the dural sinuses causing headache, abnormal vision, weakness of the face and limbs on one side of the body, and seizures.Magne?c Resonance Venography (MRV) is one of the preferred methods of evalua?on of the cerebral venous sinus anatomy, varia?ons and pathology, par?cularly in the diagnosisof venous sinus thrombosis. The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Aim:The purpose of this study is to evaluate the use of MRV to depict the normal intracranial venous anatomy and its variants in North Indian popula?on, which can help to avoid poten?al pi?alls in the diagnosis of dural venous sinus thrombosis, venous infarcts and venous hemorrhage. Materials:The present study was undertaken in the Departments of Anatomy and Radiodiagnosis at a North Indian ter?ary care teaching hospital over a period of two years. Magne?c Resonance Venograms (MRV) of pa?ents a?ending the radiology department were used to study the normal anatomy and varia?ons in the dural venous sinuses. 50 MRV scans of which 26 were of females and 24 of male, were included in the study. Anatomical varia?ons and varia?ons in drainage of the dural venous sinuses were assessed and sta?s?cal analysis was done. Results:For both superior sagi?al sinus drainage and straight sinus drainage, the propor?on of veins draining in right and le? transverse sinuses and confluence of sinuses was significantly different in the two age groups (p<0.001) in both males and females. Par?al spli?ng of superior sagi?al sinus in anterior one third or posterior one third was also seen. Sta?s?cally significant findings were observed regarding the laterality for vein of Labbe & vein of Trolard. Conclusion:MR venography is an excellent diagnos?c technique to visualise anatomy and anatomic varia?ons of venous sinuses as observed in our study. The par?al spli?ng of superior sagi?al sinus in either anterior one third or posterior one third as seen in our study, can cause misdiagnosis of thrombosis. Hence, knowledge of normal anatomy and anatomic varia?ons in the intracranial venous sinuses is very important to diagnose cerebral venous sinus thrombosis accurately.

Cerebral Hemodynamics in Chronic Disorders of Cerebral Circulation

The experience of using different methods of magnetic resonance study of the arterial and venous parts of the vascular bed of the head and neck is analyzed, and the feasibility and possibility of simultaneous assessment of the state of the brain and the study of the anatomy of the cerebral bed are shown. 87 patients with chronic cerebral ischemia (CCI) on the background of hypertension (GB) were examined, of the 36 women and 51 men aged from 46 to 72 years. Allpatients underwent standard neurological examination, MRI of the brain with venography (MRV) of the brachiocephalic veins and venous sinuses of the brain, duplex scanning (DS) in the modes of color Doppler mapping and pulsed Doppler of extra-and intracranial vessels. Comparative assessment of brain MRI results in patients with CCI revealed diffuse changes in the signal intensity from the white matter of the brain (periventricular, subcortical leucoarea, LA), single or multiple ischemic foci of 115 mm, external and internal cerebral atrophy (CA). the feasibility and the possibility of a one-stage assessment of the state of the brain and the study of the anatomy of the cerebral bed are substantiated. The need for an extended magnetic resonance study of the vascular system in the defeat of the arterial bed of the brain is due to certain anatomical and functional relationships between the arterial and venous sections

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients.Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study.According to the type of stent,the patients were divided into two groups,BMS group (n=46)and CS group (n=20).The demographic data,clinical signs and symptoms,and pre-procedure and post-procedure imaging data were followed up and recorded.The primary patency rates were calculated at 1,3,6,9,and 12 months.Results The related symptoms were improved within 2 day post-procedure.The primary patency rates of BMS group in 1,3,6,9 and 12 months were 97.83％,95.65％,69.56％,41.3％,and 34.78％ respectively.The rates of CS group were 100％,100％,95％,65％,and 60％respectively.They did not reached statistical significance for primary patency rates between two groups in 1,3,and 6 months (P ＞ 0.05 respectively).However,from 9 months after procedure,it began to show the significant difference between two groups (P ＜ 0.05).The median patency time of the CS group was (10.30±5.32) months,while BMS group was (8.52±0.49) months.The difference between the two groups was statistically significant (P=0.046).Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect.The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.

Image Quality and Radiation Dose in CT Venography Using Model-Based Iterative Reconstruction at 80 kVp versus Adaptive Statistical Iterative Reconstruction-V at 70 kVp

OBJECTIVE: To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp. MATERIALS AND METHODS: Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B. RESULTS: Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups. CONCLUSION: CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.

The diagnostic value of direct CT venography in lower extremity deep venous thrombosis / 实用放射学杂志

Objective To discuss the diagnostic value of direct computed tomography venography (CTV)in lower extremity deep venous thrombosis (DVT).Methods The image data of 57 lower extremity DVT cases examined by direct CTV were analyzed retrospectively,and compared with X-ray digital subtraction angiography (DSA).Results 55 cases with 63 DVT of lower extremity veins were detected by direct CTV.The positive rate of diagnosis of direct CTV was 96.49% (55/57).23 cases were peripheral type,19 cases central type, 23 cases mixed type.The imaging findings of DVT in direct CTV were the blocked or discontinued vein and filling defection,collateral circulation was showed in 8 cases.Conclusion Direct CTV may show the position,size and shape of the DVT,and is simple,safe and less contrast agent, which is one of the important method of DVT diagnosis.

Magnetic Resonance Venography Findings of Obstructed Hepatic Veins and the Inferior Vena Cava in Patients with Budd-Chiari Syndrome

OBJECTIVE: This study aimed to illustrate the magnetic resonance venography (MRV) manifestations of obstructed hepatic veins (HVs), the inferior vena cava (IVC), and accessory hepatic veins (AHVs) in patients with Budd-Chiari syndrome (BCS) and to evaluate the visualization capacity of MRV in the diagnosis of BCS. MATERIALS AND METHODS: Fifty-two patients with chronic BCS were included in this study. All patients were examined via MRV performed with a 3T system following injections of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) or Gd-ethoxibenzyl-DTPA. HV and IVC lesions were classified, and their characteristics were described. HV cord-like occlusions detected via MRV were compared using ultrasonography (US). Digital subtraction angiography (DSA) was performed as a contrast in the MRV detection of IVC lesions. The HVs draining collaterals, mainly AHVs, were carefully observed. HV lesions were classified as segmental stenosis, segmental occlusion, membranous stenosis, membranous occlusion, cord-like occlusion, or non-visualized. Except for patent IVCs, IVC lesions were classified as segmental occlusion, segmental stenosis, membranous occlusion, membranous stenosis, and hepatomegaly-induced stenosis. RESULTS: All patients (52/52, 100%) showed HV lesions of different degrees. MRV was inferior to US in detecting cord-like occlusions (6 vs. 19, χ2 = 11.077, p < 0.001). Dilated AHVs, including 50 (50/52, 96.2%) caudate lobe veins and 37 (37/52, 71.2%) inferior HV and AHV lesions, were well-detected. There were no significant differences in detecting segmental lesions and thrombosis between MRV and DSA (χ2 = 0.000, p1 = 1.000, p2 = 1.000). The capacity of MRV to detect membranous lesions was inferior to that of DSA (7 vs. 15, χ2 = 6.125, p = 0.013). CONCLUSION: In patients with BCS, MRV can clearly display the lesions in HVs and the IVC, as well as in AHVs, and it has diagnostic and therapeutic value.

Value of computed tomographic venography in the diagnosis of iliac vein stenosis or occlusion / 中华普通外科杂志

Objective To evaluate computed tomography venography (CTV) in diagnosis of iliac vein stenosis or occlusion.Methods From Jun 2015 to Jun 2017,168 CVD patients with CEAP clinically graded at 4 to 6 underwent evaluation with digital subtraction angiography (DSA) CTV and colour Doppler ultrasound.Taking DSA as standard,the diagnostic value of CTV and colour Doppler ultrasound were analyzed and compared.Results DSA established diagnosis of 95 cases,compared with DSA,CTV's and colour Doppler ultrasound's sensitivity,specificity,positive likelihood ratio and negative likelihood ratio was 87.4％ and 64.2％,94.5％ and 98.6％,15.89 and 45.86 and 0.13 and 0.36.Compared with colour Doppler ultrasound,CTV's sensitivity was significantly higher (P ＜ 0.05,the 95 ％ confidence intervals were 0.764-14.257),and there was no significant difference between them in aspect of specificity (P =0.375,the 95％ confidence intervals were 0.943-0.986),Kappa value was 0.809(P ＜0.05,the 95％ confidence intervals were 0.714-0.893),0.597 (P ＜ 0.05,the 95％ confidence intervals were 0.464-0.717).Conclusion In the diagnosis of CVD combined with iliac and femoral venous stenosis,CTV has outstanding sensitivity,specificity,and good conformancy with that of DSA.

The Usefulness of Duplex Ultrasound for Hemodialysis Access Selection

PURPOSE: A native vessel is preferable to an artificial graft for dialysis access. Duplex ultrasound (DUS) is noninvasive, cost-effective modality to evaluate the vessels for dialysis. The purpose of this study was to compare the rates of utilization of native vessels after preoperative imaging with DUS and contrast venography (CV). MATERIALS AND METHODS: A retrospective review was performed on patients who received an arteriovenous fistula (AVF) or arteriovenous graft (AVG) between June 2006 and July 2010. Patients were classified into 3 groups. In group 1, CV was used to evaluate the vessel. Both DUS and CV were used in group 2. In group 3, only DUS was used. The frequency of utilization of a native vessel was analyzed in each group. The chi-square test was used for statistical analysis. RESULTS: During the study period, 173 patients received an AVF or AVG. Eighty-nine patients were male. The mean age was 60.6±14.6 years. A native vessel was used in 56/81 patients (69.1%) and 74/81 patients (91.4%) in groups 1 and 3, respectively (P<0.001). In group 2, all patients underwent access procedures using native vessels. AVG was initially planned for 2 patients in group 2 after vessel evaluation using CV, but a native vessel was successfully used because DUS identified optimal vessels for AVF. The 1-year primary patency rate was similar in 3 groups. CONCLUSION: Preoperative DUS is safe and easy to use for vessel evaluation, and can be used as a primary imaging modality for creation of access.

The diagnostic value of direct MSCTV for lower extremity deep venous obstructive disease / 实用放射学杂志

Objective To explore the diagnostic value of dual syringe and dual-channel direct multi-slice computed tomography venography(MSCTV) for lower extremity deep venous obstructive disease.Methods 100 patients highly suspected deep vein thrombosis by clinic wereunderwent dual syringe and dual-channel direct MSCTV.The original data processed with technology of subtraction,and put into workstation and reconstructed with maximum intensity projection(MIP),multiplanar reformation(MPR) and volume rendering (VR).Images of deep venous obstructive lesions were analysed and graded.All patients were underwent DSA in one week.Results Direct MSCTV showed that the reconstructed images and the vascular contrast were very clear.In the evaluation of deep venous,excellent proportion was 95 ％ for the inferior vena cava,94 ％ for the common iliac vein,95 ％ for the external iliac vein,95.5 ％ for the femoral vein,96.5％ for the popliteal vein and 92 ％ for the low leg vein.Direct MSCTV displayed complete and regular vein in 8 normal patients,92 cases displayed different parts and different degrees of thrombosis.On original axial images,eccentric filling defect of vascular were showed (there were 64 multiple vein occlusion cases and 28 solitary obstruction cases).The occlusion locations in deep venous were as following:3 in the inferior vena cava,67 in the common iliac vein,28 in the external iliac vein,50 in the femoral vein,26 in the popliteal vein,89 in the anterior tibial vein,35 in the posterior tibial vein and 5 in the peroneal vein.There were 7 normal patients and 93 patients with different parts and different degrees of thrombosis.Conclusion Direct MSCTV can accurately show deep vein thrombosis,which image is clear and reliable for displaying the scope and extent of lesions of the vascular and whether the collateral circulation established.Direct MSCTV has a significant clinical value in diagnosing the thrombotic disease of deep vein obstructive lesions.

Clinical value of magnetic resonance venography in diagnosing Cockett syndrome / 介入放射学杂志

Objective To evaluate non-enhancement magnetic resonance venography (MRV) of iliac vein in diagnosing Cockett syndrome.Methods Magnetic resonance iliac venography was performed with Ingenia 3.0 T superconducting type MRI system.Abdominal surface coil was employed.The scanning sequences included M2DIPEAR (TR/TE=45/5.8 ms,flip angle=60°),THRIVE (TR/TE=6.8/3.5 ms,flip angle=10°),BTFESPAIR (TR/TE=3.4/1.7 ms,flip angle=80°) and FLAIR (TR/TE=9 000/120 ms,flip angle 90°).The layer thickness of 3 mm was used in all scanning,and the average number of acquisition was 3 times.Results On MRV imaging,Cockett syndrome was characterized by narrowed anteroposterior diameter and broadened transverse diameter of the compressed iliac vein,and curved impression could be seen on its anterior border,and collateral vessel formation could be observed.The mean diameters of the left iliac veins in the light,mnedium and severe patients with Cockett syndrome were 7.52,4.83 and 2.76 mm respectively,with the average compression ratios being 37％,69％ and 83％ respectively.Conclusion Non-enhanced MRV is a feasible method for the diagnosis of iliac vein stenosis,this examination is especially suitable for the checking needs of specific population.

The application of combined venography in the diagnosis of iliac vein compression syndrome with dual-source CT / 实用放射学杂志

Objective To explore the clinical value of the combined dual-source CT venography(CTV)for the diagnosis of iliac vein compression syndrome(IVCS).Methods 43 patients with clinically suspected IVCS underwent CTV examination.Among them,22 cases were assessed with combined CTV while 21 cases were given conventionally indirect CTV.The lower extremity deep vein was scanned from foot to head.The dual-energy technology was applied for data acquisition.Results Two kinds of CTV methods could be used directly for diagnosing IVCS and checking the asymptomatic mild iliac vein compression.32 IVCS patients were diagnosed by CTV.In 27 cases with deep venous thrombosis(DVT),the average diameter of the left iliac vein was(3.23 ± 1.45)mm and the average compression rate was 67%.The differences were statistically significant in comparisons of the average diameter of left iliac vein between IVCS patients with or without DVT and patients without IVCS.The image quality scores of bidirectional CTV were higher than indirect CTV with statistically significant difference.Conclusion Combined CTV is a feasible technique for lower extremity venography.The image quality of combined CTV is better than conventional indirect CTV with greater clinical value.

Application of CT venography in diagnosis and treatment of Budd-Chiari syndrome / 重庆医学

Objective To investigate the application value of CT venography(CTV) in the diagnosis and treatment of Budd‐Chiari syndrome(BCS) .Methods 58 patients with BBCS in our hospital from January 2012 to January 2014 were performed the CTV examination .The inferior vena cava ,hepatic vein ,portal vein and collateral vessels were performed the reconstruction analysis . Results All the patients were definitely diagnosed as BCS after completing CTV examination ,including :19 cases of inferior vena cava(IVC) diaphragm type ,15 cases of short IVC segment occlusion ,8 cases of long IVC segment occlusion ,9 cases of hepatic vein stenosis or occlusion ,7 cases complicated by fresh thrombosis .In addition ,the different degrees of compensatory expansion of col‐lateral vesse ,intuition and comprehensiveness ,can display the position ,character and length of lesion vessel ,also observes the de‐grees of collateral vessels expansion and liver cirrhosis .

Anatomical Variations of Cerebral MR Venography: Is Gender Matter? / 신경중재치료의학

PURPOSE: Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. MATERIALS AND METHODS: A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. RESULTS: A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. CONCLUSION: Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

The value of 320 slice volume CT venography and ultrasound in diagnosis of lower extremity deep vein thrombosis / 实用放射学杂志

Objective To study the value of 320 slice volume CT venography (CTV)and ultrasound in the diagnosis of lower limb deep vein thrombosis(DVT).Methods 51 patients with DVT confirmed by DSA were analyzed retrospectively,with comparing detection rate by direct method of CTV and ultrasound of the emboli in different parts of lower limb.Results In 5 1 patients,48 cases with DVTs were detected by CTV,including 124 thrombi,and 46 cases by ultrasound,finding 86 thrombi.CT diagnosed 34 pelvic deep vein thrombi,and ultrasound found 10.CT diagnosed 25 tibiofibular vein thrombi,and ultrasound found 5.CT diagnosed 2 femoral deep vein thrombi,and ultrasound found 1 1.Conclusion Direct method of CTV and ultrasound have high clinical value in the diagnosis of deep venous thrombosis,the former is better for the thrombosis in the pelvic deep veins and tibiofibular vein,while the latter is better for the thrombosis in the femoral deep vein.

Non-invasive MDCT Pulmonary Angiography in Unselected Patients with suspected Pulmonary Thrombo- Embolism.

Background: Pulmonary Thrombo-Embolism (PE) is a common and potentially lethal complication of deep venous Thrombosis (DVT). High sensitivity and specificity of Multi Detector Computed Tomography Pulmonary Angiography (MDCT-PA) in direct visualization of embolic material within the pulmonary arteries is due to its improved spatial and temporal resolution. Methods: We conducted a Prospective study to evaluate Non-invasive 256 Slice MDCT-PA in one hundred unselected patients with clinically suspected Pulmonary Embolism. Results: The total number of patients with thrombo-embolic disease in our study was 35 (35%), out of which acute PE & acute DVT were observed in 32% and 8% respectively. The percentage of Sub-segmental emboli among patients with acute PE was 34.37%, segmental thrombi was 87.5% and central thrombi was 96.87%.Conclusion: MDCT-PA possess the advantage of direct visualization and quantification of thrombo-embolic material and hence we advocate it to be the first-line imaging study for patients with clinically suspected PE.

Subtraction MR Venography Acquired from Time-Resolved Contrast-Enhanced MR Angiography: Comparison with Phase-Contrast MR Venography and Single-Phase Contrast-Enhanced MR Venography

OBJECTIVE: To evaluate the image characteristics of subtraction magnetic resonance venography (SMRV) from time-resolved contrast-enhanced MR angiography (TRMRA) compared with phase-contrast MR venography (PCMRV) and single-phase contrast-enhanced MR venography (CEMRV). MATERIALS AND METHODS: Twenty-one patients who underwent brain MR venography (MRV) using standard protocols (PCMRV, CEMRV, and TRMRA) were included. SMRV was made by subtracting the arterial phase data from the venous phase data in TRMRA. Co-registration and subtraction of the two volume data was done using commercially available software. Image quality and the degree of arterial contamination of the three MRVs were compared. In the three MRVs, 19 pre-defined venous structures (14 dural sinuses and 5 cerebral veins) were evaluated. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the three MRVs were also compared. RESULTS: Single-phase contrast-enhanced MR venography showed better image quality (median score 4 in both reviewers) than did the other two MRVs (p < 0.001), whereas SMRV (median score 3 in both reviewers) and PCMRV (median score 3 in both reviewers) had similar image quality (p ≥ 0.951). SMRV (median score 0 in both reviewers) suppressed arterial signal better than did the other MRVs (median score 1 in CEMRV, median score 2 in PCMRV, both reviewers) (p < 0.001). The dural sinus score of SMRV (median and interquartile range [IQR] 48, 43-50 for reviewer 1, 47, 43-49 for reviewer 2) was significantly higher than for PCMRV (median and IQR 31, 25-34 for reviewer 1, 30, 23-32 for reviewer 2) (p < 0.01) and did not differ from that of CEMRV (median and IQR 50, 47-52 for reviewer 1, 49, 45-51 for reviewer 2) (p = 0.146 in reviewer 1 and 0.123 in reviewer 2). The SNR and CNR of SMRV (median and IQR 104.5, 83.1-121.2 and 104.1, 74.9-120.5, respectively) were between those of CEMRV (median and IQR 150.3, 111-182.6 and 148.4, 108-178.2) and PCMRV (median and IQR 59.4, 49.2-74.9 and 53.6, 43.8-69.2). CONCLUSION: Subtraction magnetic resonance venography is a promising MRV method, with acceptable image quality and good arterial suppression.

Application of three-dimensional magnetic resonance imaging and DSA in the diagnosis of cerebral venous sinus thrombosis / 中国脑血管病杂志

Objective To investigate the diagnostic value of three-dimensional magnetic resonance imaging (MRV ) and digital subtraction arteriography (DSA ) in cerebral venous sinus thrombosis (CVST). Methods Twenty-nine patients with CVST admitted to the First Affiliated Hospital of the Third Military Medical University (Southwest Hospital)from January 2008 to February 2014 were enrolled retrospectively. Eleven of them were males and 18 were females. Their course of disease ranged from 3 days to 3 months. Nine patients were in the acute phase (2 weeks). All the patients were underwent magnetic resonance (MR)(T1 or T2 weighted image ),three-dimensional MRV,and DSA examinations. Results DSA detected 29 and MRV detected 24 patients. MRI revealed 12 patients had cerebral infarction and 7 had cerebral infarct and hemorrhage. On T2-weighted sequences,16 patients showed the flow void effect of venous sinus disappeared,and thromboses with different signals in the sinuses. MRV showed part development of the veins in 14 cases and no development in 10 cases,including 4 with collateral circulation. Compared with DSA,the positive detection rate of MRV was 82. 8%. The lesion sites of 3 patients involving the transverse sinus and 2 involving the sagittal sinus were not detected on MRV. Conclusion Compared with DSA,the MRV has a certain percentage of missed diagnosis rate for CVST. In clinical work,if MRV diagnosis is negative,it can not exclude the diagnosis of CVST,and further DSA examination is needed.

Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients

OBJECTIVE: To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients. METHODS: A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling. RESULTS: DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients. CONCLUSION: CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.

Análisis del rol de la venografía de extremidades inferiores por tomografía computada en pacientes con sospecha clínica de tromboembolismo pulmonar / Analysis of the role of ct venography of lower limbs in patients with clinically suspected pulmonary embolism

Objetivos. Determinar el rol de la venografía por tomografía computada e identificar variables que determinen el diagnóstico de trombosis venosa profunda de extremidades inferiores en pacientes con sospecha clínica de TEP y sometidos a angiografía de tórax por tomografía computada. Diseño. Cohorte retrospectiva que evaluó 151 pacientes en los que se realizó venografía de extremidades inferiores - angiografía de tórax mediante tomografía computada. Se tabularon factores de riesgo como la edad, sexo, servicio de proveniencia, riesgo para TEP (según score de Wells), ecotomografía Doppler de EEII previa y sus resultados, diagnóstico y lugar anatómico de TEP y diagnóstico y lugar anatómico de TVP según los resultados obtenidos con la venografía. Resultados. Se dispuso de información completa para 151 pacientes. 40 fueron positivo para TEP (26,5%) y 13 venografías resultaron positivas (8.6% del total). Los casos provenían en un 41,7% de Urgencia; 31,1% de UPC; 19,8% hospitalizados (no crítico); y 7,2% de consultas ambulatorias. De las variables estudiadas, ninguna resultó estadísticamente significativa para predecir el hallazgo de trombosis venosa profunda en concomitancia con la angiografía pulmonar mediante TC. En aquellos pacientes con ultrasonido Doppler contemporáneo, la venografía por tomografía computada no aportó nueva información de aquella ya disponible. Conclusiones. En este estudio no se encontraron variables que a priori apoyen la realización de una fase venográfica en concomitancia con una angiografía de tórax mediante tomografía computada cuando existe la sospecha clínica de tromboe-mbolismo pulmonar. No se justificaría realizar venografía por TC en pacientes con hemodinamia estable y sospecha de TEP.

Objectives. To determine the role of CT venography and identify variables that determine the diagnosis of deep venous thrombosis (DVT) of lower extremities in patients with clinical suspicion of PE, and who underwent chest CT angiography. Design. Retrospective group study that evaluated hundred fifty-one patients in whom lower extremity venography- chest CT angiography was performed. Risk factors were tabulated - such as age, sex, department origin, risk of PE (according to Wells Criteria), previous Doppler ultraso-nography of lower extremities and their results, diagnosis and anatomical site of PE, and diagnosis and anatomical site of DVT according to the results obtained with the venography. Results. Complete data was available for 151 patients. 40 were positive for PE (26.5 percent) and 13 venographs were positive (8.6percent of the total). The case origins were 41.7 percent from Emergency Department, 31.1 percent from ICU, 19.8 percent hospitalized (non-critical) and 7.2 percent from outpatient consultations. Of the variables studied, none resulted statistically significant for predicting the discovery of deep vein thrombosis in conjunction with CT pulmonary angio-graphy. In those patients with contemporary Doppler ultrasound, the CT venography did not provide new information from that already available. Conclusions. In this study we did not find variables that support a priori the realization of a venography phase in conjunction with chest CT angiogram when there is clinical suspicion of pulmonary embolism. Performing CT venography in patients with stable hemodynamics and suspected PE, would not be justified.