MR imaging of cerebral venous infarctions and thrombosis

ABSTRACT

Thrombosis of the cerebral veins although uncommon represents a life threatening complication of different diseases. To improve survival and reduce debilitating complications, early recognition and institution of appropriate therapy are essential. Currently, this entity is more commonly seen idiopathically [a] in association with pregnancy, puerperium or use of oral contraceptives in adult women, or [b] in patients with systemic tumors. Arteriography and radionuclide techniques are invasive and require puncture of a vessel, injection of a pharmaceutical substance, and the use of ionizing radiation. The less invasive CT scan may indicate the presence of dural sinus, occlusion however CT signs may be subtle and easily overlooked. This study was performed on 16 cases with an established diagnosis of cerebral venous infarction and thrombosis; all of them had an MRI study, 8 cases had CT scan without contrast enhancement; and 2 cases had angiography. We found that MRI is a superior modality in diagnosing dural sinus thrombosis; either by observing signal changes in T1WI or T2WI; or by directly visualizing the thrombus after Gad-DTPA injection or using MR angiography techniques. In addition MR may disclose the possible cause of thrombosis e.g. mastoiditis; and characterize venous infarction occurring secondary to thrombosis