ARTICLE INFO

Article Type

Original Research

Authors

Bagheri   A. (1)
Faeghi   F. (*)
Rabbani   M. (2)
Jabbari   K. (3)






(*) Radiology Technology Department, Allied Medical Sciences School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(1) International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(2) Radiology Department, Medicine School, Isfahan University of Medical Sciences, Isfahan, Iran
(3) Medical Physics & Engineering Department, Medicine School, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence

Address: Para Medical University, Darband Street, Tehran, Iran
Phone: +982122718531
Fax: +982122721150
f.faeghi@yahoo.com

Article History

Received:  April  4, 2015
Accepted:  June 24, 2015
ePublished:  September 20, 2015

BRIEF TEXT


… [1-4] Magnetic resonance imaging (MRI) has been known as the best non-invasive imaging method for monitoring sinus venous thrombosis [5-8]. Susceptibility Weighted Imaging (SWI) is one of the new techniques in magnetic resonance imaging method that uses pulse sequence of a gradient echo T2*-weighted [9, 10]. … [11-20] SWI has complementary diagnostic value in displaying clot in the venous sinus thrombosis due to its sensitivity of susceptibility effects [21].

Non-declared

The aim of this study was to evaluate different sequences of magnetic resonance imaging and magnetic susceptibility imaging to display venous sinus thrombosis.

This is a cross-sectional study.

Patients with sinus venous thrombosis referred to Shafa Imaging Center in Isfahan (Iran) from August, 2013 to September, 2014were studied.

12 patients (11 women and a man) were referred to imaging center to carry out MRI with protocols T1W, T2W, SW1 and PC-MRV in coordination with a neurologist physician.

Imaging was carried out with a device with the power of 1/5 tesla (Siemens Avanto, Germany). For brain imaging, special 8-channel coil was used. To investigate cerebral venous thrombosis, a number of the sequence including (1) axial T1 spin-echo, (2) axial, coronal and sagittal T2 fast spin echo, (3) axial T2SWI, and (4) PC-MRV was used as standard references to diagnose of cerebral venous sinus thrombosis. Based on previous studies, the results were divided into three groups and each group received a score. A group of visible results which were enough for diagnosis received two scores. Another group which was slightly visible and was not enough for diagnosis received one score, and the third group which was undetectable received no score [22, 23].

The patients included 11 females (91.7%) and a male (8.3%). The mean age was 40.92 ± 12.14years. Based on taken history of patients, 8 (66.6%) of them were using contraception pills, and 10 (83.3%) complained of headache. Of 12 patients with cerebral venous sins thrombosis, 3 (25%) of patients were in the acute phase (during the first 5 days after the onset of symptoms until imaging), and other 9 (75%) participants were in under-acute phase (6 to 15 days after the onset of symptoms until imaging). 6 patients had superior sagittal sinus thrombosis; 2 had inferior sagittal sinus thrombosis; 3 patients had right transverse sinus thrombosis; 3 patients had left transverse sinus thrombosis; 3 patients had right sigmoid sinus thrombosis; 3 patients had left sigmoid sinus thrombosis; 2 patients had right jugular vein, 4 had left jugular vein; and one had direct sinus thrombosis and vein of Galen in the sub-acute stage. 2 patients had left transverse sinus thrombosis, and one had left sigmoid thrombosis in the acute period. Venous sinus thrombosis was common first in superior sagittal sinus with the frequency of 6 patients (50%) and then, in the left transverse sinus with a frequency of 5 patients (41.7%). In T1W sequence, 50% of the patients received zero; one score was given to 41.7% and two score were given to 8.3% of patients. In T2W sequence, 25% of them received zero; one score was given to 25% of patients, and two scores were given to 50% of patients. In SW1 sequence, 0% of patients received zero; one score was given to 25% of participants; and two scores were given to 75% of patients. Finally, in PC-MRV sequence, zero percent of participants received zero; one score was given to zero percent of patients, and two scores were given to 100% of patients. Sagittal sinus, transverse and sigmoid thromboses were detectable in sub-acute stage (Figures 1 and 4). Sigmoid and transverse thromboses were observed partially in the acute phase, but there were not enough for diagnosis (Figure 3). Jugular vein thrombosis, due to magnetic susceptibility artifact of temporal bones, was not detectable (Figure 1). There was a straight sinus thrombosis in the sub-acute stage which was detectable in the data. There were two cases of lower sagittal sinus thrombosis in data in the sub-acute stage which were detectable (Figure 4). In all participants, cerebral venous thrombosis was detectable in acute and sub-acute stages (Figures 2, 3, and 4). One case of transverse and sigmoid sinuses and left jugular vein thromboses were detectable in sub-acute stage on T1W images. Two cases of superior sagittal sinus thrombosis, one case of left sigmoid sinus thrombosis and left jugular vein in the sub-acute stage were slightly observed in T2W images, but they were not enough for diagnosis. In other cases, venous sinus thrombosis was detectable in T2W images in sub-acute stage (Figure 2). Straight sinus thrombosis was detectable in sub-acute stage in T2W images. Sigmoid and transverse sinus thrombosis was not detectable in the acute stage in T1W and T2W images (Figure 3). Lower sagittal sinus thrombosis was not detectable in sub-acute stage in T1W and T2W images (Figure 4).

The incidence of thrombosis in women compared to men is three to one, and it is mainly due to the consumption of contraceptive pills by women [24]. The prevalence of this disease in women (91.7%) was higher, and this prevalence was due to the consumption of contraceptive pills. 83.3% of patients complained of headaches and this finding is consistent with the results of other studies (81% of 110 cases, and 82% of 40 cases) [25, 26]. Superior sagittal sinus (50%) was the most common venous sinus thrombosis, and after that it was left transverse sinus (41.6%). These results agree with the results of other studies which show that superior sagittal sinus (62%) and left transverse sinus (44.7%) are the most common place of thrombosis in 624 cases, respectively [27]. Gradient echo T2*W sequence is more sensitive to paramagnetic effects compared to spin echo sequences, and the susceptibility effect of venous thrombosis (in Dura mater sinuses and venous cortical sinuses) was shown in gradient echo technique, and T2 gradient echo sequence and its susceptibility thrombosis effect is helpful in the diagnosis of thrombosis in the acute phase. This effect is significant in the venous section of acute phase which was related to susceptibility effects of dioxide hemoglobin [28]. The results of the current study showed that thrombosis produces a magnetic susceptibility in the acute phase (dioxide hemoglobin) and sub-acute phase (met hemoglobin), and leads to reduction of signal in SWI images. SWI is more sensitive to paramagnetic effects compared to spin echo sequences (T1W, T2W). T2*SWI has a complementary diagnostic value in detection of brain venous thrombosis, especially when the sensitivity of other sequences (T1W, T2W and FLAIR) is less. The results of this study, also, showed that SWI was more sensitive in depicting venous sinus thrombosis compared to T1W and T2W [29]. T2* gradient echo sequence is more sensitive to paramagnetic effects compared to T1W, T2W and FlAIR, and the sequences such as flair and T1W with injection are not useful in displaying thrombosis in the acute phase. Gradient echo T2* sequence has high diagnostic value in primary detection of venous sinus thrombosis, and it is more effective in displaying cerebral vein thrombosis which is shown in T2W images with low signal intensity [22]. The results of current study showed that PC-MRV sequence is very useful in diagnosis of venous sinus thrombosis in the acute and sub-acute stages. Also, SWI is not helpful in the diagnosis of venous sinus thrombosis in the sub-acute stage. However, it is not useful in the acute stage.

SWI should be added to MRI and MRV routine sequences as a complementary sequence in venous sinus thrombosis diagnosis. PC-MRV sequence should be considered as a golden standard in diagnosis of venous sinus thrombosis. In patients with cerebral venous thrombosis, in addition to routine sequences of MRI, MRV and SWI, conventional gradient echo T2*W sequence should be used, and the findings of SWI sequence should be compared with the findings of conventional gradient echo T2*W.

Limited imaging centers, high cost of imaging, and the way of interpreting data of magnetic susceptibility were the limitations of this study.

Magnetic susceptibility imaging has high diagnostic value in displaying superior sagittal sinus, transverse sinus and sub-acute sigmoid thrombosis.

Research Department of International Branch of Shahid Beheshti University of Medical sciences and Shafa Imaging Center are appreciated.

There was no conflict of interest.

The current research was recorded in International Research Branch of Shahid Beheshti University of Medical Sciences.

This project has been funded by the author.

TABLES and CHARTS

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