Prenatal Diagnosis of Cerebral Venous Pathologies: Findings in Diffusion-Weighted Imaging (DWI), Time-of-Flight (TOF), and Gradient-Echo Sequences

Abstract

Venous sinus thrombosis is a serious disease and 40 % of survivors develop neurologic sequelae; mortality may be as high as 10 % [1]. In childhood, more than 40 % cerebral venous sinus thromboses occur within the neonatal period, with an incidence of 2.6 per 100,000 children per year [2, 3]. The unique characteristics of fetal superficial and deep venous systems are important for the diagnosis of venous anomalies in utero. The major prenatally diagnosed venous anomalies in utero are the thrombosed dural sinus malformations (tdsM) and Galen vein aneurysms (GVA) [1, 4]. There are a number of case series that define the routine T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MrI) features of fetal cerebral venous pathologies [5–11]. However, evaluation of venous anomalies is challenging even in the neonatal period, especially in equivocal cases [2, 12, 13]. With the advent of faster MrI sequences, the application of advanced neuroradiology sequences has increased in the neonatal period. However, fetal application of sequences like diffusion-weighted imaging (dWI), gradient-echo (Gre) T2* imaging, 2d time-offlight MR angiography (TOF MRA), and MR venography (MrV) in the antenatal period has been limited so far. In designing this study, our purpose is to evaluate the antenatally detected cerebral venous pathologies with various MrI sequences.