DOI: 10.1148/rg.26si055174
Imaging of Cerebral Venous Thrombosis: Current Techniques, Spectrum of Findings, and Diagnostic Pitfalls1
James L. Leach, MD,
Robert B. Fortuna, MD,
Blaise V. Jones, MD and
Mary F. Gaskill-Shipley, MD
1 From the Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman St, Cincinnati, OH 45246 (J.L.L., R.B.F., M.F.G.S.); the Neuroscience Institute, Cincinnati, Ohio (J.L.L., M.F.G.S.); and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (B.V.J.). Recipient of a Cum Laude award for an education exhibit at the 2004 RSNA Annual Meeting. Received September 19, 2005; revision requested January 13, 2006 and received February 17; accepted April 6. All authors have no financial relationships to disclose.
View larger version (90K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1. MIP image from contrast-enhanced MR venography, with a color overlay, demonstrates the superior dural sinuses. They include the superior sagittal sinus (green), inferior sagittal sinus (light blue), straight sinus (dark purple), confluence of the sinuses (orange), transverse sinuses (dark blue), and sigmoid sinuses (yellow). The internal jugular veins and bulbs (light purple) also are depicted.
|
|
View larger version (122K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2. Lateral MIP image from contrast-enhanced MR venography, with editing of the deep veins to improve the visibility of the ascending veins that drain into the superior sagittal sinus from the lateral hemispheric cortex (the frontopolar [1], anterior frontal [2], and posterior frontal [3] veins; Trolard vein [superior anastomotic vein] [4]; and anterior parietal veins [5]) and the larger named veins on the lateral surface of the cerebrum (the superficial sylvian vein [superficial middle cerebral vein] [6], which typically drains into the sphenoparietal sinus or the cavernous sinus, and the Labbé vein [7], which drains into the transverse sinus). The relative luminal diameters of the Trolard vein, Labbé vein, and superficial sylvian veins are reciprocal.
|
|
View larger version (133K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3. Axial MR image series with a color overlay represents the major superficial cortical venous drainage territories according to Meder et al (21). Most of the superior cerebrum (green) is drained primarily into the superior sagittal sinus, which also receives drainage from the parasagittal cortical regions at lower levels. The sylvian veins drain blood from the peri-insular region (yellow) into the basal dural sinuses. The transverse sinuses receive blood from the temporal, parietal, and occipital lobes (blue). The Labbé vein, if dominant, may drain much of this territory. Parenchymal abnormalities such as hemorrhage or edema in this territory may be indicative of thrombosis of the transverse sinus or Labbé vein.
|
|
View larger version (77K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4. Lateral MIP image from contrast-enhanced MR venography shows the major components of the deep venous system: the thalamostriate vein (1), septal vein (2), internal cerebral vein (3), basal vein (Rosenthal vein) (4), and vein of Galen (5).
|
|
View larger version (153K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5. Axial MR image with color overlay shows the drainage territory of the deep cerebral veins (internal cerebral vein, vein of Galen) (pink), in which parenchymal abnormalities due to deep venous occlusion typically are found. The deep white matter (medullary) venous drainage territory (blue) also is shown.
|
|
View larger version (94K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 6. Basal dural sinuses. Anteroposterior MIP image from contrast-enhanced MR venography, with the superficial and deep veins removed for better visualization, shows the cavernous sinus complex (1) and, connecting the lateral dural sinuses with the cavernous sinus, the superior petrosal sinuses (2), which arise from the junction of the transverse and sigmoid sinuses and extend along the petrous ridge, and the inferior petrosal sinuses (3), which arise from the distal portion of the sigmoid sinus or jugular bulb and extend along the clivus. Also visible are the superficial middle cerebral vein (sylvian vein) (4), which in this case extends into the cavernous sinus, and the emissary veins and occipital venous plexus complex (5).
|
|
View larger version (156K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 7a. (a, b) Lateral MR venograms show the coronal (vertical white line in a) and axial (horizontal white line in b) planes of image data acquisition used for TOF MR venography. The distal portion of the superior sagittal sinus (arrow in a), which is located in the coronal plane, is poorly depicted on coronal TOF MR venograms. The horizontal portion of the superior sagittal sinus (straight arrows in b), the junction of the vein of Galen with the straight sinus (arrowhead in b), and the portions of the transverse sinus that are located in the axial plane (curved arrow in b) are poorly depicted on axial TOF MR venograms. Poor depiction of these areas may lead to misdiagnosis of occlusion at TOF MR venography. (c) Image from contrast-enhanced MR venography provides better depiction of all the venous structures.
|
|
View larger version (121K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 7b. (a, b) Lateral MR venograms show the coronal (vertical white line in a) and axial (horizontal white line in b) planes of image data acquisition used for TOF MR venography. The distal portion of the superior sagittal sinus (arrow in a), which is located in the coronal plane, is poorly depicted on coronal TOF MR venograms. The horizontal portion of the superior sagittal sinus (straight arrows in b), the junction of the vein of Galen with the straight sinus (arrowhead in b), and the portions of the transverse sinus that are located in the axial plane (curved arrow in b) are poorly depicted on axial TOF MR venograms. Poor depiction of these areas may lead to misdiagnosis of occlusion at TOF MR venography. (c) Image from contrast-enhanced MR venography provides better depiction of all the venous structures.
|
|
View larger version (188K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 7c. (a, b) Lateral MR venograms show the coronal (vertical white line in a) and axial (horizontal white line in b) planes of image data acquisition used for TOF MR venography. The distal portion of the superior sagittal sinus (arrow in a), which is located in the coronal plane, is poorly depicted on coronal TOF MR venograms. The horizontal portion of the superior sagittal sinus (straight arrows in b), the junction of the vein of Galen with the straight sinus (arrowhead in b), and the portions of the transverse sinus that are located in the axial plane (curved arrow in b) are poorly depicted on axial TOF MR venograms. Poor depiction of these areas may lead to misdiagnosis of occlusion at TOF MR venography. (c) Image from contrast-enhanced MR venography provides better depiction of all the venous structures.
|
|
View larger version (143K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 8. Cerebral venous thrombosis in a 5-year-old girl with mastoiditis of the right ear. MIP image from CT venography with subtraction of the calvaria shows filling defects in the right transverse sinus (arrows), findings consistent with thrombosis. A persistent falcine sinus (arrowhead) was an incidental finding.
|
|
View larger version (135K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 10a. (a) Contrast-enhanced CT image in a patient with superior sagittal sinus thrombosis shows a central filling defect in the superior sagittal sinus (arrow), surrounded by intensely enhanced dura mater. (b) Coronal reformatted image from contrast-enhanced MR venography in another patient shows a nonenhanced thrombus (arrows) surrounded by enhanced sinus walls and dural cavernous spaces. The thrombus extends from the superior sagittal sinus through the sinus confluence and into the right transverse sinus.
|
|
View larger version (136K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 10b. (a) Contrast-enhanced CT image in a patient with superior sagittal sinus thrombosis shows a central filling defect in the superior sagittal sinus (arrow), surrounded by intensely enhanced dura mater. (b) Coronal reformatted image from contrast-enhanced MR venography in another patient shows a nonenhanced thrombus (arrows) surrounded by enhanced sinus walls and dural cavernous spaces. The thrombus extends from the superior sagittal sinus through the sinus confluence and into the right transverse sinus.
|
|
View larger version (138K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 11a. Acute thrombus in a 35-year-old woman with a severe headache for 5 days. (a, b) Axial T2-weighted MR image (a) and axial T1-weighted MR image (b) show a thrombus in the left sigmoid sinus (arrows). The signal in the thrombus, compared with that in the normal brain parenchyma, is hypointense in a and iso- to hyperintense in b. (c) Frontal MIP image from coronal TOF MR venography shows a lack of flow in the distal portion of the left transverse sinus and the sigmoid sinus (arrows).
|
|
View larger version (144K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 11b. Acute thrombus in a 35-year-old woman with a severe headache for 5 days. (a, b) Axial T2-weighted MR image (a) and axial T1-weighted MR image (b) show a thrombus in the left sigmoid sinus (arrows). The signal in the thrombus, compared with that in the normal brain parenchyma, is hypointense in a and iso- to hyperintense in b. (c) Frontal MIP image from coronal TOF MR venography shows a lack of flow in the distal portion of the left transverse sinus and the sigmoid sinus (arrows).
|
|
View larger version (122K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 11c. Acute thrombus in a 35-year-old woman with a severe headache for 5 days. (a, b) Axial T2-weighted MR image (a) and axial T1-weighted MR image (b) show a thrombus in the left sigmoid sinus (arrows). The signal in the thrombus, compared with that in the normal brain parenchyma, is hypointense in a and iso- to hyperintense in b. (c) Frontal MIP image from coronal TOF MR venography shows a lack of flow in the distal portion of the left transverse sinus and the sigmoid sinus (arrows).
|
|
View larger version (126K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 12a. Subacute thrombus of the superior sagittal sinus. (a, b) Axial T1-weighted (a) and axial T2-weighted (b) MR images show an area of abnormal increased signal intensity in the superior sagittal sinus (arrow). (c) Sagittal source image from contrast-enhanced MR venography shows filling defects (arrows) due to a thrombus.
|
|
View larger version (152K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 12b. Subacute thrombus of the superior sagittal sinus. (a, b) Axial T1-weighted (a) and axial T2-weighted (b) MR images show an area of abnormal increased signal intensity in the superior sagittal sinus (arrow). (c) Sagittal source image from contrast-enhanced MR venography shows filling defects (arrows) due to a thrombus.
|
|
View larger version (157K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 12c. Subacute thrombus of the superior sagittal sinus. (a, b) Axial T1-weighted (a) and axial T2-weighted (b) MR images show an area of abnormal increased signal intensity in the superior sagittal sinus (arrow). (c) Sagittal source image from contrast-enhanced MR venography shows filling defects (arrows) due to a thrombus.
|
|
View larger version (140K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 13a. Chronic thrombosis of the left transverse and sigmoid sinuses in a 69-year-old man with a chronic headache. (a, b) Axial unenhanced (a) and contrast-enhanced (b) T1-weighted images show an area of the left transverse sinus (arrow) that has isointense signal on a and intensely increased signal on b. The marked contrast enhancement in this case could easily be confused with a normal state of slow flow, which commonly occurs in the left transverse sinus. Venographic techniques therefore were necessary to evaluate sinus patency. (c) Oblique MIP image from coronal TOF MR venography shows an absence of signal in the left transverse sinus, left sigmoid sinus, and left internal jugular vein (arrows) but normal flow in the right transverse sinus, right sigmoid sinus, and right internal jugular vein (arrowheads). (d) Sagittal source image from contrast-enhanced MR venography shows multiple filling defects (arrows) in the recanalized vessels.
|
|
View larger version (135K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 13b. Chronic thrombosis of the left transverse and sigmoid sinuses in a 69-year-old man with a chronic headache. (a, b) Axial unenhanced (a) and contrast-enhanced (b) T1-weighted images show an area of the left transverse sinus (arrow) that has isointense signal on a and intensely increased signal on b. The marked contrast enhancement in this case could easily be confused with a normal state of slow flow, which commonly occurs in the left transverse sinus. Venographic techniques therefore were necessary to evaluate sinus patency. (c) Oblique MIP image from coronal TOF MR venography shows an absence of signal in the left transverse sinus, left sigmoid sinus, and left internal jugular vein (arrows) but normal flow in the right transverse sinus, right sigmoid sinus, and right internal jugular vein (arrowheads). (d) Sagittal source image from contrast-enhanced MR venography shows multiple filling defects (arrows) in the recanalized vessels.
|
|
View larger version (153K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 13c. Chronic thrombosis of the left transverse and sigmoid sinuses in a 69-year-old man with a chronic headache. (a, b) Axial unenhanced (a) and contrast-enhanced (b) T1-weighted images show an area of the left transverse sinus (arrow) that has isointense signal on a and intensely increased signal on b. The marked contrast enhancement in this case could easily be confused with a normal state of slow flow, which commonly occurs in the left transverse sinus. Venographic techniques therefore were necessary to evaluate sinus patency. (c) Oblique MIP image from coronal TOF MR venography shows an absence of signal in the left transverse sinus, left sigmoid sinus, and left internal jugular vein (arrows) but normal flow in the right transverse sinus, right sigmoid sinus, and right internal jugular vein (arrowheads). (d) Sagittal source image from contrast-enhanced MR venography shows multiple filling defects (arrows) in the recanalized vessels.
|
|
View larger version (113K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 13d. Chronic thrombosis of the left transverse and sigmoid sinuses in a 69-year-old man with a chronic headache. (a, b) Axial unenhanced (a) and contrast-enhanced (b) T1-weighted images show an area of the left transverse sinus (arrow) that has isointense signal on a and intensely increased signal on b. The marked contrast enhancement in this case could easily be confused with a normal state of slow flow, which commonly occurs in the left transverse sinus. Venographic techniques therefore were necessary to evaluate sinus patency. (c) Oblique MIP image from coronal TOF MR venography shows an absence of signal in the left transverse sinus, left sigmoid sinus, and left internal jugular vein (arrows) but normal flow in the right transverse sinus, right sigmoid sinus, and right internal jugular vein (arrowheads). (d) Sagittal source image from contrast-enhanced MR venography shows multiple filling defects (arrows) in the recanalized vessels.
|
|
View larger version (140K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 14a. Magnetic susceptibility effects on MR images in a 27-year-old postpartum woman with a severe headache for 6 days. (a) T1-weighted spin-echo image shows an area of isointense signal (arrowheads) indicative of a thrombus in the right transverse sinus. (b) GRE image shows significantly diminished signal intensity and apparent enlargement of the sinus in the same area (arrows). No flow was demonstrated at TOF MR venography.
|
|
View larger version (157K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 14b. Magnetic susceptibility effects on MR images in a 27-year-old postpartum woman with a severe headache for 6 days. (a) T1-weighted spin-echo image shows an area of isointense signal (arrowheads) indicative of a thrombus in the right transverse sinus. (b) GRE image shows significantly diminished signal intensity and apparent enlargement of the sinus in the same area (arrows). No flow was demonstrated at TOF MR venography.
|
|
View larger version (114K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 15. Oblique MIP image from TOF MR venography in a patient with a history of extensive thrombosis of the superior sagittal sinus and left transverse sinus 2 years before. Note the irregular appearance of the superior sagittal sinus (arrows), which corresponds to incomplete recanalization of the sinus. The source images showed residual intrasinus defects, intra-sinus channels, and dural collateral channels.
|
|
View larger version (142K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 16. Frontal MIP image from axial TOF MR venography in a patient with prior extensive thrombosis and variable recanalization of the superior sagittal sinus, straight sinus, and both transverse sinuses. Veins of the face and scalp were subtracted for better visualization of the irregular cortical venous collateral vessels (arrows), which drain primarily to the superficial middle cerebral veins and to the sphenoparietal, cavernous, and inferior petrosal sinuses. Tentorial collateral vessels also are visible (arrowhead).
|
|
View larger version (121K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 17a. Parenchymal edema. Axial T2-weighted images obtained at the initial presentation (a) and 2 months later, after anticoagulation therapy (b), in a patient with segmental thrombosis of the superior sagittal sinus at MR venography. In a, note the focal signal abnormality in the right frontal lobe; the extensive signal abnormality in the white matter extending along the subcortex, consistent with vasogenic edema (arrows); and the high-signal-intensity thrombus in the anterior part of the superior sagittal sinus (arrowhead). In b, only a small zone of encephalomalacia remains, and the white matter edema has resolved. A small zone of hypointense T2 signal (arrowhead in b) consistent with hemorrhage also is visible.
|
|
View larger version (119K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 17b. Parenchymal edema. Axial T2-weighted images obtained at the initial presentation (a) and 2 months later, after anticoagulation therapy (b), in a patient with segmental thrombosis of the superior sagittal sinus at MR venography. In a, note the focal signal abnormality in the right frontal lobe; the extensive signal abnormality in the white matter extending along the subcortex, consistent with vasogenic edema (arrows); and the high-signal-intensity thrombus in the anterior part of the superior sagittal sinus (arrowhead). In b, only a small zone of encephalomalacia remains, and the white matter edema has resolved. A small zone of hypointense T2 signal (arrowhead in b) consistent with hemorrhage also is visible.
|
|
View larger version (96K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 18a. Superior sagittal sinus thrombosis and parenchymal changes in the right parietal lobe. (a, b) Diffusion-weighted image (a) and T2-weighted image (b) obtained at presentation show an area of increased signal intensity consistent with diffusion restriction along the cortex of the right parietal lobe (arrow in a) and corresponding T2 signal abnormality (arrowheads in b). Also visible is a high-signal-intensity thrombus in the superior sagittal sinus (arrow in b). (c) T2-weighted image obtained 7 months later shows minimal atrophy in the zone of previous diffusion restriction (arrowhead) and resolution of the thrombus (arrow).
|
|
View larger version (111K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 18b. Superior sagittal sinus thrombosis and parenchymal changes in the right parietal lobe. (a, b) Diffusion-weighted image (a) and T2-weighted image (b) obtained at presentation show an area of increased signal intensity consistent with diffusion restriction along the cortex of the right parietal lobe (arrow in a) and corresponding T2 signal abnormality (arrowheads in b). Also visible is a high-signal-intensity thrombus in the superior sagittal sinus (arrow in b). (c) T2-weighted image obtained 7 months later shows minimal atrophy in the zone of previous diffusion restriction (arrowhead) and resolution of the thrombus (arrow).
|
|
View larger version (106K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 18c. Superior sagittal sinus thrombosis and parenchymal changes in the right parietal lobe. (a, b) Diffusion-weighted image (a) and T2-weighted image (b) obtained at presentation show an area of increased signal intensity consistent with diffusion restriction along the cortex of the right parietal lobe (arrow in a) and corresponding T2 signal abnormality (arrowheads in b). Also visible is a high-signal-intensity thrombus in the superior sagittal sinus (arrow in b). (c) T2-weighted image obtained 7 months later shows minimal atrophy in the zone of previous diffusion restriction (arrowhead) and resolution of the thrombus (arrow).
|
|
View larger version (154K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 19. Occlusion of the anterior superior sagittal sinus. Coronal contrast-enhanced T1-weighted image shows patchy areas of varied enhancement in both frontal lobes (arrows), findings that correspond to zones of diffusion restriction noted on diffusion-weighted images (not shown).
|
|
View larger version (152K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 20a. Axial CT images from three patients with sinus thrombosis. (a) Typical irregularly shaped right frontal lobe hemorrhage (arrows) in a patient with superior sagittal sinus thrombosis. (b) Right temporal lobe hemorrhage with extensive edema (arrow) in a patient with right transverse sinus thrombosis. (c) Small subcortical hemorrhages (arrows) in the left frontal and parietal lobes in a patient with superior sagittal sinus thrombosis.
|
|
View larger version (139K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 20b. Axial CT images from three patients with sinus thrombosis. (a) Typical irregularly shaped right frontal lobe hemorrhage (arrows) in a patient with superior sagittal sinus thrombosis. (b) Right temporal lobe hemorrhage with extensive edema (arrow) in a patient with right transverse sinus thrombosis. (c) Small subcortical hemorrhages (arrows) in the left frontal and parietal lobes in a patient with superior sagittal sinus thrombosis.
|
|
View larger version (101K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 20c. Axial CT images from three patients with sinus thrombosis. (a) Typical irregularly shaped right frontal lobe hemorrhage (arrows) in a patient with superior sagittal sinus thrombosis. (b) Right temporal lobe hemorrhage with extensive edema (arrow) in a patient with right transverse sinus thrombosis. (c) Small subcortical hemorrhages (arrows) in the left frontal and parietal lobes in a patient with superior sagittal sinus thrombosis.
|
|
View larger version (161K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 21a. Thrombosis of the straight sinus, vein of Galen, and internal cerebral veins. (a) Axial intermediate-weighted image shows extensive signal abnormalities within both thalami and extending into the caudate nuclei (arrows). (b) Sagittal two-dimensional phase-contrast MR venogram demonstrates a portion of the deep venous system with no signal (arrows), a finding consistent with occlusion.
|
|
View larger version (143K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 21b. Thrombosis of the straight sinus, vein of Galen, and internal cerebral veins. (a) Axial intermediate-weighted image shows extensive signal abnormalities within both thalami and extending into the caudate nuclei (arrows). (b) Sagittal two-dimensional phase-contrast MR venogram demonstrates a portion of the deep venous system with no signal (arrows), a finding consistent with occlusion.
|
|
View larger version (85K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 22a. Isolated cortical vein thrombosis in a 71-year-old woman with a headache and mental status change. Axial T1-weighted image (a) and axial T2-weighted image (b) show thrombosis of the cortical vein, with T1 signal hyperintensity (arrow in a) and T2 signal isointensity (arrow in b). Mild edema also is visible in the adjacent brain parenchyma (arrowhead in b). No evidence of dural sinus thrombosis was found.
|
|
View larger version (83K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 22b. Isolated cortical vein thrombosis in a 71-year-old woman with a headache and mental status change. Axial T1-weighted image (a) and axial T2-weighted image (b) show thrombosis of the cortical vein, with T1 signal hyperintensity (arrow in a) and T2 signal isointensity (arrow in b). Mild edema also is visible in the adjacent brain parenchyma (arrowhead in b). No evidence of dural sinus thrombosis was found.
|
|
View larger version (114K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 23a. Pseudotumor cerebri in a 47-year-old woman with elevated cerebrospinal fluid pressure documented at lumbar puncture. Oblique volume-rendered images from contrast-enhanced MR venography show a hypoplastic right transverse sinus (arrowhead in a) and prominent smooth-bordered stenoses in distal portions of both the right (arrows in a) and the left (arrow in b) transverse sinuses. The morphologic structure of the stenoses is suggestive of extraluminal compression. Parenchymal images showed no alteration in signal intensity that might be indicative of acute or subacute thrombosis.
|
|
View larger version (133K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 23b. Pseudotumor cerebri in a 47-year-old woman with elevated cerebrospinal fluid pressure documented at lumbar puncture. Oblique volume-rendered images from contrast-enhanced MR venography show a hypoplastic right transverse sinus (arrowhead in a) and prominent smooth-bordered stenoses in distal portions of both the right (arrows in a) and the left (arrow in b) transverse sinuses. The morphologic structure of the stenoses is suggestive of extraluminal compression. Parenchymal images showed no alteration in signal intensity that might be indicative of acute or subacute thrombosis.
|
|
View larger version (150K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 24. Transverse sinus atresia. Oblique MIP image from coronal TOF MR venography shows the complete absence of the medial part of the left transverse sinus (arrows), a finding confirmed at contrast-enhanced MR venography. No abnormal signal intensity was noted on images obtained with other MR sequences.
|
|
View larger version (163K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 25a. Transverse sinus flow gap. (a) Coronal image from TOF MR venography shows an apparent interruption of flow in the medial part of the left transverse sinus (arrows). (b) Oblique MIP image from contrast-enhanced MR venography shows enhancement indicative of normal flow in the medial part of the left transverse sinus (arrow).
|
|
View larger version (183K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 25b. Transverse sinus flow gap. (a) Coronal image from TOF MR venography shows an apparent interruption of flow in the medial part of the left transverse sinus (arrows). (b) Oblique MIP image from contrast-enhanced MR venography shows enhancement indicative of normal flow in the medial part of the left transverse sinus (arrow).
|
|
View larger version (129K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 26a. Anomalous location of the superior sagittal sinus bifurcation. (a) Anteroposterior MIP image from TOF MR venography shows a high bifurcation of the superior sagittal sinus (arrow). (b) On the axial contrast-enhanced CT image, the early bifurcation of the sinus produces a pseudo empty delta sign (arrow), mimicking sinus thrombosis.
|
|
View larger version (112K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 26b. Anomalous location of the superior sagittal sinus bifurcation. (a) Anteroposterior MIP image from TOF MR venography shows a high bifurcation of the superior sagittal sinus (arrow). (b) On the axial contrast-enhanced CT image, the early bifurcation of the sinus produces a pseudo empty delta sign (arrow), mimicking sinus thrombosis.
|
|
View larger version (62K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 27a. Classic appearance of arachnoid granulations. (a) Photograph from an anatomic dissection of the right transverse sinus demonstrates focal protuberances consistent with arachnoid granulations (arrows). Intrasinus septa (chordae willisii) (arrowheads) also are depicted. (b, c) Axial contrast-enhanced CT image (b) and superoinferior MIP image from contrast-enhanced MR venography (c) show well-defined focal filling defects consistent with arachnoid granulations in the lateral part of the transverse sinus (arrow), the most common site of such findings.
|
|
View larger version (54K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 27b. Classic appearance of arachnoid granulations. (a) Photograph from an anatomic dissection of the right transverse sinus demonstrates focal protuberances consistent with arachnoid granulations (arrows). Intrasinus septa (chordae willisii) (arrowheads) also are depicted. (b, c) Axial contrast-enhanced CT image (b) and superoinferior MIP image from contrast-enhanced MR venography (c) show well-defined focal filling defects consistent with arachnoid granulations in the lateral part of the transverse sinus (arrow), the most common site of such findings.
|
|
View larger version (66K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 27c. Classic appearance of arachnoid granulations. (a) Photograph from an anatomic dissection of the right transverse sinus demonstrates focal protuberances consistent with arachnoid granulations (arrows). Intrasinus septa (chordae willisii) (arrowheads) also are depicted. (b, c) Axial contrast-enhanced CT image (b) and superoinferior MIP image from contrast-enhanced MR venography (c) show well-defined focal filling defects consistent with arachnoid granulations in the lateral part of the transverse sinus (arrow), the most common site of such findings.
|
|
View larger version (107K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 28. T1-shortening shine-through in a patient with thrombosis of the superior sagittal sinus and transverse sinuses. Lateral MIP image from coronal TOF MR venography shows an area of thrombosis with a signal of intermediate intensity (arrows) resembling that of normal sinus flow but less intense than that in patent cortical veins (arrowheads). The signal in the thrombus was markedly hyperintense on T1-weighted images (not shown).
|
|
Copyright © 2006 by the Radiological Society of North America.
