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Imaging Dural Sinus Thrombosis

F. Allan Midyett¹, Suresh Mukherji¹, Laurie Fisher¹

¹University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A2.1

DOI:

10.1002/0471142719.mia0201s00

Online Posting Date:

May, 2001

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Abstract

The acute onset of irreversible neurological deficit is referred to as a “stroke” and is the third leading cause of death and the major cause of adult long-term disability in the United States. Obstruction of the venous sinuses by thrombosis accounts for ~1% of strokes. Thrombosis of the superior saggital sinus is most frequent, with involvement of transverse, sigmoid, and cavernous sinuses occurring less often. Venous thrombosis may involve the dural sinuses, the deep venous system, and the superficial cortical veins separately or in any combination. This unit describes a Basic Protocol for imaging dural sinuses by time-of-flight magnetic resonance venography (MRV).

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Unit Introduction
Basic Protocol: Imaging Dural Sinuses by Time-of-Flight MRV
Commentary
Bibliography
Figures
Tables

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Figures

Figure A2.1.1

Superior sagittal thrombosis with bright T₁ signal from thrombus.

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Figure A2.1.2

Superior sagittal sinus thrombosis with increased T₁ signal. This is less bright than the previous example.

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Figure A2.1.3

Superior sagittal sinus thrombosis with T₁ signal, which is almost isointense with brain.

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Figure A2.1.4

Occlusion of transverse sinus with high T₁ signal in clot.

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Figure A2.1.5

Superior sagittal sinus thrombosis with partial blockage on MRV.

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Figure A2.1.6

Superior sagittal sinus thrombosis with total occlusion on MRV.

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Figure A2.1.7

Occlusion transverse sinus on transverse MRV.

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Figure A2.1.8

Occlusion transverse sinus on coronal MRV.

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Literature Cited

Literature Cited
	Bianchi, D., Maeder, P., Bogousslavsky, J., Schnyder, P., and Meuli, R. 1998. Diagnosis of cerebral venous thrombosis with routine magnetic resonance: An update. Eur. Neurol. 40:179-190.
	Cure, J.K. and Van Tassel, P. 1994. Congenital and acquired abnormalities of the dural venous sinuses. Seminars US, CT, Magn. Reson. Imaging 15:520-539.
	Fischbein, N.J., Dillon, W.P., and Barkovich, A.J. 2000. Teaching Atlas of Brain Imaging. pp. 248-249, 329-332. Thieme, New York.
	Shellock, F.G. and Kanal, E. 1996. Magnetic Resonance Bioeffects, Safety and Patient Management. Lippincott Williams and Wilkins, Philadelphia.
	Tsai, F.Y., Wang, A., Matovich, V.B., Lavin, M., Berberian, B., Simonson, T.M., and Yuh, W.T. 1995. MR staging of acute dural sinus thrombosis: Correlation with venous pressure measurements and implications for treatment and prognosis. Am. J. Neuroradiol. 16:1021-1029.
	Yuh, W.T., Simonson, T.M., Wang, A.M., Koci, T.M., Tali, E.T., Fisher, D.J., Simon, J.H., Jinkins, J.R., and Tsai, F. 1994. Venous sinus occlusive disease: MR findings. Am. J. Neuroradiol. 15:309-316.
Key References
	Bianchi et al., 1998. See above.
These authors describe the importance of MRI and MRV in the diagnosis and follow-up of cerebral venous thrombosis. They point out how different signals on spin echo T₁- and T₂-weighted images evolve according to hemoglobin degradation causing pitfalls and artifacts that must be recognized.
	Fischbein et al., 2000. See above.
These authors afford a current concise look at dural sinus thrombosis. In addition to imaging findings, they discuss, clinical findings, treatment, complications, pearls, and pitfalls.
	Shellock and Kanal, 1996. See above.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.