Role of MRI in Cerebral Venous Thrombosis

Abstract

Abstract Background Cerebral venous thrombosis CVT is a type of stroke where the thrombosis occurs in the venous side of the brain circulation, leading to occlusion of one or more cerebral veins and Dural venous sinus. CVT is a potentially life-threatening disease, accounting for approximately 0.5 % of stroke cases. Aim of the Work The aim of this subject is to illustrate the various aspects of CVT on MRI. Patients and Methods This is a retrospective study included 30 patients (19 females &11 males), their ages range from 3 months to 74 years with the median age 22 years. Mean age 22.04 years. The study was performed in radiology department El Demerdash Hospital between March 2018 & September 2019. The study included patients presented to the Medical Imaging Department of Ain Shams university Al-Demerdash hospital with cerebral venous occlusion neurological symptoms or imaging diagnosis. Results In our study,. Most common presenting symptom was headache noted in 22 patients (73.3%) followed by eye manifestations (blurring of vision or clinically having papilledema) was the second most seen in 18 patients (60%). Then comes convulsions in8 patients (26.7 %), Limb weakness in 5 patients (16.7%), finally disturbed consciousness level in 4 patients (13.3%). Most common mode of onset was subacute which was seen in 16 patients (53.3%) acute onset was seen in 6 patients (20%) as predominantly isointense on T1 weighted images and hypo intense on T2 weighted images, chronic onset was seen in 8 patients (26.7%) as hypo intense signal in both T1 and T2 WIs. MRV successfully diagnosed occlusion in most cases by absence of signal intensity with consequent non-visualization of occluded sinuses or veins in almost all patients and except 3 patients; those were having just cortical veins thrombosis detected by T2* sequence electing blooming artifacts with intact sinuses, and dilated distal collaterals seen in 18 patients. Conclusion Dural venous occlusion can occur due to many factors as thrombosis, inflammatory conditions of the brain and tumors. Cerebral venous thrombosis (CVT) has long been a neglected entity because of complexities in diagnosis and non-specific clinical presentation. Conventional MRI and phase contrast MRV in conjugation with recent techniques such SWI & DWI were considered more accurate diagnostic tool, non invasive, non ionizing, with high resolution in evaluating patients with suspected cerebral venous occlusion or thrombosis. It is also considered very useful to demonstrate brain parenchymal affection, the age or stage of the thrombus and its extension