Article Figures & Data
Figures
- Fig 1.
Fifty-six-year-old woman with subacute left proximal lateral sinus thrombosis (duration of symptoms, 5 days). The arteriovenous transit of a contrast bolus is depicted on the dynamic series of combo-4D MRV (A–E; coronal MIP reformations of time-resolved contrast-enhanced MRV; temporal interval between images, 1.5 seconds). At early venous phase, faint filling of cortical veins and the superior sagittal sinus is noted (B). At subsequent later venous phase, the left proximal transverse sinus does not show increased contrast filling other than very faint peripheral enhancement of its dural wall (long arrow in C). At following later venous phases, no increase in contrast filling of this sinus portion is observed (long arrow in D and E). On axial static image of combo-4D MRV (contrast-enhanced 3D VIBE sequence), a hypointense filling defect within the proximal left transverse sinus is depicted (small arrow in F).
- Fig 2.
Twenty-five-year-old man with subacute thrombosis (thrombus age, 4 days) of posterior portion of superior sagittal sinus, torcular region, and right lateral sinus. Sagittal source image of static VIBE part of combo-4D MRV reveals large isointense filling defect within posterior portion of superior sagittal sinus extending into torcular area (long white arrow in A). On sagittal whole-brain MIP reconstructed image of 2D TOF MRV, most of this thrombus shows hyperintense signal intensity mimicking flow. The small vertical signal intensity gap (short white arrow in B) was misinterpreted as artifact on a single section derived from in-plane signal intensity loss (coronal acquisition). No flow signal intensity is depicted in thrombosed right lateral sinus.
- Fig 3.
Seventy-six-year-old man with acute venous thrombosis involving left parietal cortical vein (thrombus age approximately 1 day). GRE image shows typical magnetic susceptibility effect with hypointense signal intensity and blooming in left parasagittal parietal cortical vein (long white arrow in A). Static 3D contrast-enhanced VIBE MR venographic images from combo-4D MRV are centered on region of interest (B and C). No evidence of cortical venous filling defect can be seen on axial image (B) and targeted axial thick-slab MIP reformation (thickness, 20 mm; C) of VIBE sequence in corresponding area. Likewise, this thrombosed cortical vein is not evident on 2D TOF MR venogram, as demonstrated by targeted axial thick-slab (thickness, 20 mm; D) and standard coronal whole-head (E) MIP reformations. On the latter image, additional thrombosis of right lateral sinus is depicted (short white arrows in E).
- Fig 4.
Fifty-three-year-old man with chronic left lateral sinus thrombosis (thrombus age approximately 7 years). Combo-4D MRV consisting of dynamic 3D contrast-enhanced MR venographic images and static 3D contrast-enhanced VIBE MR venographic images. Upper panel, Coronal MIP reformations of combo-4D MRV demonstrate chronic thrombosis of the left lateral sinus. On early venous phase image of the dynamic MRV series (A), a thin channel of contrast enhancement is depicted within a large gap inside the left transverse/sigmoid sinus (long arrow). An increase in this contrast enhancement is noted at the subsequent later venous phase (time delay of 1.5 seconds between dynamic images) on the corresponding image (long arrow, B). On the static MRV image (C), intense contrast-enhancement mimicking patency of these sinuses is disclosed (long arrow). Note also focal postthrombotic changes inside the right lateral sinus (short arrows) without dynamic contrast enhancement. Middle panel, Targeted axial oblique MIP reformations (parallel to the course of the lateral sinuses) of combo-4D MRV show more clearly the dynamic enhancement patterns of chronic left lateral sinus thrombosis (D–F). Lower panel: On corresponding axial GRE image, no relevant magnetic susceptibility effect is observed in the affected venous sinuses (G; short arrow and arrowheads). On T2W image, chronic thrombus reveals an isointense signal intensity (H; short arrow and arrowheads). Complete loss of normal flow signal intensity in left lateral sinus and jugular bulb, as well as irregular signal intensity void at the right transverse/sigmoid sinus junction are depicted on coronal MIP reformation of 2D-TOF MRV (I).
- Fig 5.
Forty-three-year-old man who underwent MR and MRV investigation for posterior fossa hemorrhage. Axial thick-slab MIP reformations of 2D TOF (A) and static part of combo-4D MRV (contrast-enhanced 3D VIBE, B) are targeted on lateral sinuses (slab thickness, 20 mm). On TOF MRV image, large flow gap in proximal transverse sinus is demonstrated (long white arrow in A). Combo-4D MRV image shows hypoplastic transverse sinus without evidence of thrombosis (short white arrow in B).
Tables
Imaging Technique T2W GRE TOF MRV Combo-4D MRV Polychoric correlation test 0.83 0.64 0.88 0.95 Binary test 0.89 0.87 0.89 0.94 - Table 2:
Average sensitivity and specificity for 2 readers and 53 sites of CVT in 39 patients assessed on venous segment level and on patient level
Imaging Technique, % (95% CI) Pair-wise Difference, P Valuea T2W GRE TOF MRV Combo-4D MRV Venous segment levelb All segments, all stages Sensitivity (n = 53) 62 (48–74) 49 (34–64) 72 (59–81) 76 (64–84) 2(.002), 5(.006) Specificity (n = 181) 98 (94–99) 98 (94–99) 96 (92–97) 99 (96–100) 3(.02) Dural venous sinuses, all stages Sensitivity (n = 34) 72 (55–84) 39 (24–57) 82 (66–92) 97 (84–100) 1(.003), 2(<.001), 3(.03), 4(.03), 5(<.001), 6(.005) Specificity (n = 122) 99 (95–100) 98 (94–99) 95 (90–97) 99 (95–100) 3(.02), 4(.007) Cortical veins, all stages Sensitivity (n = 19) 45 (27–64) 66 (46–81) 53 (35–69) 37 (20–58) 2(.01) Specificity (n = 59) 95 (86–99) 97 (87–100) 98 (89–100) 99 (91–100) All segments Sensitivity, acute stage (n = 16) 56 (25–85) 56 (36–74) 75 (44–96) 63 (44–76) N/A Sensitivity, subacute stage (n = 31) 63 (48–75) 50 (29–71) 71 (57–80) 84 (67–94) N/A Sensitivity, chronic stage (n = 6) 75 (36–94) 20 (6–61) 67 (32–88) 67 (30–90) N/A Patient level, all stagesc Sensitivity (m = 20) 75 (56–85) 55 (38–71) 83 (63–91) 90 (69–97) 2(<.001), 5(.002) Specificity (m = 19) 97 (77–100) 95 (74–100) 79 (58–90) 100 (80–100) 3(.009), 4(.04) Note:—n refers to the number of venous segments included in the calculation; m refers to the number of patients included in the calculation.
a Superscripts 1, 2, 3, 4, 5, and 6 indicate significant difference between combo-4D MRV and T2W, combo-4D MRV and GRE, combo-4D MRV and TOF MRV, TOF MRV and T2W, TOF MRV and GRE, and between GRE and T2W, respectively.
b Binary test on venous segment level, ie, test is positive if score is >3.
c Binary test on patient level, ie, test is positive for patient if score >3 for any of the patient's venous segments.
- Table 3:
AUC and comparisons between imaging techniques for 2 readers and 53 sites of cerebral venous thrombosis in 39 patients
AUC Estimate Pair-wise Difference, P Value Reader 1 Reader 2 Average (95% CI) All veins Combo-4D MRV 0.94 0.90 0.92 (0.88–0.96) a(.03), b(.03) TOF MRV 0.92 0.93 0.93 (0.88–0.97) c(.005), d(.02) GRE 0.83 0.89 0.86 (0.81–0.91) T2W 0.85 0.83 0.84 (0.78–0.91) Dural venous sinuses Combo-4D MRV 0.98 1.00 0.99 (0.97–1.00) a(.005), b(<.001) TOF MRV 0.95 0.96 0.96 (0.92–1.00) c(.01), d(<.001) GRE 0.81 0.87 0.84 (0.79–0.89) T2W 0.89 0.91 0.90 (0.84–0.96) Cortical veins Combo-4D MRV 0.87 0.73 0.80 (0.70–0.90) TOF MRV 0.87 0.90 0.89 (0.78–0.99) c(.01), e(.02) GRE 0.85 0.91 0.88 (0.78–0.97) T2W 0.77 0.70 0.74 (0.60–0.87) Note:—Superscripts a, b, c, d, and e indicate significant differences between combo-4D MRV and T2W, combo-4D MRV and GRE, TOF MRV and T2W, TOF MRV and GRE, and between TOF MRV and combo-4D MRV, respectively.
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