Cerebral Magnetic Resonance Venography Research Articles

Anatomical Variations of the Superior Sagittal, Transverse and Sigmoid Dural Venous Sinuses in the Cerebral MRV Images of Adult Bangladeshis

Background: The understanding of the dural venous sinus anatomy and normal anatomical variations is fundamental for appropriate diagnosis of cerebral venous sinus pathology and also for surgical planning and treatment of neurological diseases. Cerebral MRV (Magnetic Resonance Venography) is an exclusive imaging technique for appropriate identification of the normal anatomical variations as well as pathology of the dural venous sinuses. Most of the variations have been detected in the superior sagittal, transverse and sigmoid venous sinuses. Objectives: To identify and determine the frequencies of some selected anatomical variations- symmetry, hypoplasia and aplasia (as applicable) of the superior sagittal, transverse and sigmoid dural venous sinuses in the cerebral MRV images of adult Bangladeshis. Methods: The research was observational in nature, carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the Department of Neuroradiology & Imaging, National Institute of Neuroscience and Hospital (NINS), Dhaka, from March 2020 to June 2021. A total of 70 adults (35 males and 35 females) Bangladeshi participants were included in this research. The MRV scans were produced by using 3 Tesla magnetic field strength following the routine standard protocols of the institution. By using the Radiant DICOM Viewer software, the MRV images were evaluated by the researcher and the co-investigator independently to identify the selected anatomical variations of the dural venous sinuses. Results: Bilateral symmetrical transverse and sigmoid sinus was found in 38% and 47% of total participants respectively. Among the variations of the transverse sinuses, the left sided hypoplastic transverse sinus was found in 17.1% participants whereas the right sided hypoplasia was found only in 2.9% participants. Regarding sigmoid sinus, hypoplasia and aplasia were found only on the left side respectively in 7.1% and 1.14% participants. ...

Morphometric Measurements of the Superior Sagittal, Transverse and Sigmoid Dural Venous Sinuses in Normal Cerebral MRV Images of Adult Bangladeshis

Background: The dural venous sinuses show different types of morphometric variations in their anatomy as well as involvement with various neurological conditions like cerebral venous sinus thrombosis, venous sinus stenosis, embolism, fistula etc. Cerebral MRV (Magnetic Resonance Venography) is a well-established radiological technique to visualize the dural venous system. By measuring the sinus dimensions in cerebral MRV images and calculating the indices, morphometric variations of the dural venous sinuses can be identified which is essential for diagnosing different pathologies of the dural venous system. Researcher have detected most of the variations in the superior sagittal, transverse and sigmoid venous sinuses. Objectives: To develop anatomical baseline data on morphometric measurements of the dural venous sinuses in normal cerebral MRV images of adult Bangladeshis. Methods: The research was cross-sectional and observational in nature. It was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the Department of Neuroradiology & Imaging, National Institute of Neuroscience and Hospital (NINS), Dhaka, from March 2020 to June 2021. Adults (35 males and 35 females) aged 18 years or above who attended in the Department of Neuroradiology & Imaging, NINS for cerebral MRV and diagnosed as having normal dural venous sinuses without any pathology by a registered Neuroradiologist were the participants of this research. The MRV scans were produced by using 3 Tesla magnetic field strength following the routine standard protocols of the institution. By using the Radiant DICOM Viewer software, a total of 9 linear and curvilinear dimensions were measured and 2 indices were calculated by the researcher and the co-investigator independently to reach consensus on each variable. Results: A numerical data set was generated on the morphometric measurements of the superior sagittal, transverse and sigmoid sinuses ......

A rare case of coexistence of Wegener\u2019s granulomatosis and pulmonary tuberculosis with subsequent development of thrombosis of the cerebral veins

BackgroundGranulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is an idiopathic systemic disease typically affecting the lungs, although other organs may also be involved.Case presentationA 28-year-old male was admitted to Baqiyatallah university hospital in Teheran (Iran) after a 3-week history of fever and productive cough. The patient gradually developed fatigue, arthralgia, hematuria, nausea, vomiting, dyspnea, hemoptysis, weight loss, oliguria and then anuria. Chest-X-ray (CXR) and computerized tomography scan revealed cavitating nodular opacities in the right lung lobe. Furthermore, plasma creatinine increased from 2.2 to 4 mg/dl in a few days. Histopathological examination of kidney biopsy revealed peri-glomerular and peri-vascular inflammation, degeneration and necrosis of the tubular epithelial lining, red blood cell casts, distorted glomerular structure, fibrin thrombi, segmental breaks of the glomerular basal membrane, disruption of Bowman's capsular membrane and crescent formation of the affected glomeruli. An abnormal CXR, an abnormal urinary sediment and a typical kidney histology were used as criteria to diagnose glomerulonefritis with poliangiitis (GPA). Bronchoalveolar lavage smear and PCR turned out positive for mycobacterium tuberculosis. After 3 months of treatment for (GPA) and tuberculosis the patient developed headache and seizure. Cerebral Magnetic Resonance Venography revealed cerebral venous thrombosis of the sinus transverse and sigmoid.ConclusionsTuberculosis may coexist with GPA, as it occurred in our patient. Since a crescentic glomerulonephritis can progress to renal failure, clinicians should always be aware of potential multiple conditions when considering differential diagnoses.

Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report

BackgroundHeat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain.Case presentationWe encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved.ConclusionsThis case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.

Anatomical Variations of Cerebral MR Venography: Is Gender Matter?

PurposeKnowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations.Materials and MethodsA retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences.ResultsA total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders.ConclusionHypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

Painful bilateral ulcerations of the hard palate

A 27-year-old woman was admitted for a gradually worsening diffuse headache. Her medical history was relevant for heavy smoking, protein S deficiency, heterozygous status for factor V Leiden, and a previous deep vein thrombosis of the right leg. She had previously been given anticoagulation therapy, which the patient discontinued on her own. Cerebral magnetic resonance venography (MRV) revealed superior sagittal sinus thrombosis, for which anticoagulant treatment was initiated. Upon admission, the patient also complained of bilateral pain and numbness on the hard palate followed 3 days later by painful ulcerations (Fig 1).

Reconstruction of vein of Labbé in temporo-occipital meningioma invading transverse sinus: technical report

Meningiomas invading major venous sinuses and veins are not uncommon. However, meningiomas involving both the transverse sinus and vein of Labbé are exceedingly rare. Venous reconstruction can be challenging after radical removal of the meningioma which invades major venous sinuses and veins. In this report, we present reconstruction of vein of Labbé in the surgery of temporo-occipital meningioma invading the transverse sinus. A 55-year-old woman was admitted to our institution with a 13-year history of focal epilepsy in the form of transient aphasia with vertigo. Cranial magnetic resonance imaging revealed a homogeneously contrast enhancing lesion measuring 40 mm in diameter in the left temporo-occipital area. Cerebral magnetic resonance venography and venous phase of cerebral digital subtraction angiography revealed invasion of the upper wall of left transverse sinus and total occlusion of the lumen of the vein of Labbé. After removal of all the tumors except the piece attached to the transverse sinus and vein of Labbé with standard neurosurgical techniques, the left transverse sinus lumen and vein of Labbé lumen were explored. The tumor tissue inside the transverse sinus and vein of Labbé were removed along with tumor-invaded venous wall. Venous reconstruction of the transverse sinus and vein of Labbé was performed using autologous dura mater as a patch for the defect. This is the first report in the literature in which the vein of Labbé was reconstructed in the surgery of temporo-occipital meningioma invading the vein of Labbé and transverse sinus together.

The upper limit of normal CSF opening pressure is related to bilateral transverse sinus stenosis in headache sufferers

There are limited data on the relationship between normal cerebrospinal fluid (CSF) opening pressure and bilateral transverse sinus stenosis (BTSS); there are also several conflicting reports about the upper limit of normal CSF opening pressure. To evaluate the influence of BTSS on the upper limit of normal CSF opening pressure, we prospectively recorded lumbar CSF opening pressures in 217 adult patients with neurological symptoms who underwent cerebral magnetic resonance venography (MRV). The CSF opening pressures ranged between 65 and 286 mmH(2)O (mean = 149.3, s.d. = 47.5). The upper limit of opening pressure in patients with both normal appearance of transverse sinuses and unilateral transverse sinus stenosis on MRV (n = 167) was 195 mmH(2)O with a range of 65-195 mmH(2)O. All patients with BTSS were headache sufferers, and the upper limit of opening pressure in patients with BTSS (n = 50) was 286 mmH(2)O with a range of 91-286 mmH(2)O. All patients with opening pressures > 200 mmH(2)O displayed BTSS, whereas only 13% of patients with a pressure < 200 mmH(2)O displayed BTSS. Our findings demonstrate that the upper limit of normal CSF opening pressure is related to BTSS, and they also highlight that headache sufferers with opening pressures > 200 mmH(2)O should be tested for BTSS by MRV.

Idiopathic Intracranial Hypertension With and Without Papilloedema in a Consecutive Series of Patients With Chronic Migraine

Chronic migraine (CM) has been associated with idiopathic intracranial hypertension without papilloedema (IIHWOP), a significant percentage of these cases occurring in obese patients with intractable headache. A prospective study from February 2005 to June 2006 was made of 62 CM patients who fulfilled International Headache Society diagnostic criteria and had cerebral magnetic resonance venography (MRV) and lumbar puncture (LP) done. Two patients were excluded, six (10%) with elevated cerebrospinal fluid (CSF) open pressure (OP), five with body mass index (BMI) > 25. None of the patients had papilloedema or abnormal MRV. BMI and CSF OP were significantly correlated (r = 0.476, P < 0.001, Pearson's correlation test). Obesity (defined as BMI > 30) was a predictor of increase in intracranial pressure (defined as OP > 200 mmH(2)O) (f = 17.26, 95% confidence interval 6.0, 8.6; P < 0.001). From our study we strongly recommend that not only intractable CM patients with high BMI, but also first diagnosed patients with BMI > 30 should be systematically evaluated by a LP to rule out IIHWOP.

Imaging of the Intracranial Venous System

Evaluation of the intracranial venous system has historically been performed with conventional catheter-based digital subtraction angiography (DSA). The continued importance of DSA can not be overstated in light of its inherent option of endovascular intervention and thrombolysis for cerebral venous thrombosis. DSA is, however, an invasive procedure with associated risks, including radiation exposure, and adverse effects of iodinated contrast medium. DSA also suffers from the limitations of 2-dimensional planar imaging. For these reasons, noninvasive imaging techniques are playing a greater role in evaluation of the intracranial venous system. This review provides an overview of the current noninvasive methods and their applications and limitations, with examples of their use in a variety of disease processes. Computed tomography venography (CTV) is discussed as well as the various types of cerebral magnetic resonance venography (MRV). When available, MR supplemented with the technique of triggered gadolinium-enhanced MRV is the method of choice for the diagnosis of dural sinus thrombosis as well as most other pathologic entities affecting the intracranial venous system.

Arterial contamination: a useful indirect sign of cerebral sino-venous thrombosis

Various imaging findings of cerebral sino-venous thrombosis (CSVT) have been described on magnetic resonance venography (MRV). The purpose of this study was to evaluate the significance of visualization of the arterial system on cerebral MRV, also described as arterial contamination, as an indirect sign of CSVT. Forty patients with a clinical suspicion of venous sinus thrombosis underwent MR imaging of the brain, followed by MRV sequence, based on 2D time of flight technique in the coronal oblique plane. Patient's clinical symptoms and signs were noted with particular interest for papilloedema. Twenty-seven patients were diagnosed to have cerebral venous thrombosis on MRV, and of these, arterial contamination was visualized in 16 patients. In the remaining 13 cases, in which there was no evidence of venous sinus thrombosis, arterial contamination was absent. The sensitivity of this finding was 59.25% (n = 16/27), specificity was 100%, positive predictive value was 100% and negative predictive value was 54.2%. Of these 16 patients with arterial contamination, 12 patients had evidence of increased intracranial pressure in the form of papilloedema. Visualization of the arterial system is a useful indirect sign of CSVT, and may be an indicator of increased intracranial pressure in these patients.

Cerebral MR Venography in Children: Comparison of 2D Time-of-Flight and Gadolinium-enhanced 3D Gradient-Echo Techniques

To prospectively compare two-dimensional (2D) time-of-flight cerebral magnetic resonance (MR) venography with gadolinium-enhanced three-dimensional (3D) gradient-echo cerebral MR venography in children. This investigation had investigational review board approval and was Health Insurance Portability and Accountability Act compliant; parental informed consent was obtained. Thirty-seven patients (20 boys, 17 girls) who ranged in age from 4 days to 15 years underwent 2D and 3D MR venography. Two pediatric neuroradiologists compared the visibility of the superior sagittal, straight, transverse, and sigmoid sinuses and the internal jugular veins on images obtained with the two sequences. In 17 (46%) of the 37 patients, the sequences were equivalent in terms of their depiction of venous anatomy. In 19 (51%) of the 37 patients, 3D MR venography was superior to 2D MR venography. Suboptimal enhancement of veins occurred in one (3%) patient at 3D MR venography. Venous anomalies suggested at 2D MR venography but not present at 3D MR venography included flow gaps in the nondominant transverse sinuses of four patients, unilateral transverse sinus atresia in eight, and a narrowed superior sagittal sinus in two. Two-dimensional MR venography results failed to reveal a persistent falcine sinus associated with straight sinus atresia in one patient and suggested transverse sinus thrombosis in two patients in whom 3D MR venography results were normal. Additionally, the extent of dural thrombosis was overestimated at 2D MR venography in one patient. As compared with 3D MR venography, 2D MR venography failed to reveal sigmoid sinus stenosis in one patient and poorly depicted posterior fossa dural sinus anatomy in two patients with dural arteriovenous fistula. Three-dimensional MR venography is often superior to 2D MR venography in the delineation of major cerebral venous structures in children. Most of the artifactual loss of vascular signal seen with the use of 2D MR venography occurred in nondominant transverse sinuses.