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Wang Z, Dandu C, Guo Y, Gao M, Lan D, Pan L, Zhou D, Ding Y, Ji X, Meng R. A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis. J Headache Pain 2023; 24:29. [PMID: 36932331 PMCID: PMC10022088 DOI: 10.1186/s10194-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. METHODS In this retrospective study from January 2019 through December 2021, we consecutively enrolled patients with a first-time confirmed diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV). In these patients, a comprehensive CVST-Score was established using magnetic resonance black-blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess the potential of using the CVST-score to evaluate ICP noninvasively and dynamically. RESULTS A total of 87 patients were included in the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP<250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP>330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, the CVST-Score was linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and >330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). CONCLUSIONS A simple and noninvasive CVST-Score can rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. The CVST-Score can aid in evaluating therapeutic responses and avoiding unnecessary invasive procedures at long-term follow-up.
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Affiliation(s)
- Zhongao Wang
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Chaitu Dandu
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Yibing Guo
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Meini Gao
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Duo Lan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Liqun Pan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Da Zhou
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yuchuan Ding
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Xunming Ji
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Ran Meng
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
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2
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Sarma A, Martin D, Pruthi S, Jones R, Little SB. Imaging the Cerebral Veins in Pediatric Patients: Beyond Dural Venous Sinus Thrombosis. Radiographics 2023; 43:e220129. [PMID: 36656758 DOI: 10.1148/rg.220129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been discussed extensively in the literature, and the associated imaging considerations are similar in pediatric and adult patients. The authors shift the focus to less frequently discussed cerebral venous diseases in pediatric patients. First, the practical embryology pertinent to malformations, syndromes, and variants such as vein of Galen aneurysmal malformation, Sturge-Weber syndrome, and developmental venous anomalies are discussed. Second, anatomic considerations that are applicable to neuroimaging in pediatric patients with cerebral venous anomalies are reviewed. In the discussion of anatomy, special attention is given to the medullary venous system that serves the cerebral white matter, superficial cortical veins (tributaries of the dural venous sinuses), and bridging veins, which carry blood from the superficial cortical veins through the potential subdural space into the dural venous sinuses. Third, the selection of imaging modalities (US, CT and CT venography, and MRI) is addressed, and various MR venographic pulse sequences (time-of-flight, phase-contrast, and contrast-enhanced sequences) are compared. Finally, a broad variety of congenital and acquired superficial and deep venous diseases in children are reviewed, with emphasis on less frequently discussed entities involving the medullary (eg, deep medullary venous engorgement and thrombosis, periventricular hemorrhagic venous infarction due to germinal matrix hemorrhage), cortical (eg, cortical venous thrombosis), and bridging (eg, acute and chronic manifestations of injury in abusive head trauma) veins, as well as the deep veins and dural venous sinuses (eg, varix). © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Asha Sarma
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Dann Martin
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Sumit Pruthi
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Richard Jones
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Stephen B Little
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
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3
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Liu L, Wu Y, Zhang K, Meng R, Duan J, Zhou C, Ji X. Anatomy imaging and hemodynamics research on the cerebral vein and venous sinus among individuals without cranial sinus and jugular vein diseases. Front Neurosci 2022; 16:999134. [PMID: 36238084 PMCID: PMC9551167 DOI: 10.3389/fnins.2022.999134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
In recent years, imaging technology has allowed the visualization of intracranial and extracranial vascular systems. However, compared with the cerebral arterial system, the relative lack of image information, individual differences in the anatomy of the cerebral veins and venous sinuses, and several unique structures often cause neurologists and radiologists to miss or over-diagnose. This increases the difficulty of the clinical diagnosis and treatment of cerebral venous system diseases. This review focuses on applying different imaging methods to the normal anatomical morphology of the cerebral venous system and special structural and physiological parameters, such as hemodynamics, in people without cranial sinus and jugular vein diseases and explores its clinical significance. We hope this study will reinforce the importance of studying the cerebral venous system anatomy and imaging data and will help diagnose and treat systemic diseases.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yan Wu
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kaiyuan Zhang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chen Zhou
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- *Correspondence: Chen Zhou,
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- Xunming Ji,
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4
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Sarrami AH, Bass DI, Rutman AM, Alexander MD, Aksakal M, Zhu C, Levitt MR, Mossa-Basha M. Idiopathic intracranial hypertension imaging approaches and the implications in patient management. Br J Radiol 2022; 95:20220136. [PMID: 35522777 PMCID: PMC10162046 DOI: 10.1259/bjr.20220136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) represents a clinical disease entity without a clear etiology, that if left untreated, can result in severe outcomes, including permanent vision loss. For this reason, early diagnosis and treatment is necessary. Historically, the role of cross-sectional imaging has been to rule out secondary or emergent causes of increased intracranial pressure, including tumor, infection, hydrocephalus, or venous thrombosis. MRI and MRV, however, can serve as valuable imaging tools to not only rule out causes for secondary intracranial hypertension but can also detect indirect signs of IIH resultant from increased intracranial pressure, and demonstrate potentially treatable sinus venous stenosis. Digital subtraction venographic imaging also plays a central role in both diagnosis and treatment, providing enhanced anatomic delineation and temporal flow evaluation, quantitative assessment of the pressure gradient across a venous stenosis, treatment guidance, and immediate opportunity for endovascular therapy. In this review, we discuss the multiple modalities for imaging IIH, their limitations, and their contributions to the management of IIH.
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Affiliation(s)
- Amir Hossein Sarrami
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - David I. Bass
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Matthew D Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Mehmet Aksakal
- Department of Radiology, University of Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, United States
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5
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Oura D, Ihara R, Myo E, Sato S, Sugimori H. Construction of super-rapid brain MRA using oblique transverse acquisition phase contrast angiography with tilted optimized non-saturated excitation pulse. Magn Reson Imaging 2021; 85:193-201. [PMID: 34715289 DOI: 10.1016/j.mri.2021.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/23/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
[Background] Magnetic resonance angiography (MRA) is one of the most important sequences to estimate a cerebrovascular disease. We often encounter poor image quality due to slow arterial flow related to aging and motion artifact caused by disturbance of consciousness. We focused on phase contrast angiography (PCA) to overcome these difficulties. PCA can reduce scan time drastically by combining transverse acquisition and partial slab setting covering entire brain arteries. However, transverse acquisition in PCA has a large difference in signal intensity between proximal and distal vessels. Therefore, we apply tilted optimized non-saturated excitation (TONE) to improve image quality. [Purpose] The purpose of this study to investigate the usefulness of TONE for PCA. [Method] We estimated the efficacy of TONE in transverse acquisition PCA using measurement of signal intensity in arteries. We compared image quality among 1 min PCA with/without TONE and time-of flight (TOF)-MRA, by visual. [Result] TONE improved the signal inhomogeneity in entire brain arteries. PCA with TONE (5°-9°) demonstrated the highest image quality. [Conclusion] Oblique transverse acquisition PCA with TONE provides superior image quality compared with TOF with similar scan time. TONE improved image quality by the homogenizing signal intensity of vessels from proximal to distal in oblique transvers acquisition PCA. Our MRA can be performed in about 1 min and provides sufficient quality to estimate brain vessels.
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Affiliation(s)
- Daisuke Oura
- Otaru General Hospital, Otaru 047-0152, Japan; Graduate School of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Riku Ihara
- Otaru General Hospital, Otaru 047-0152, Japan
| | | | | | - Hiroyuki Sugimori
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan.
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Bai C, Wang Z, Stone C, Zhou D, Ding J, Ding Y, Ji X, Meng R. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis 2021; 12:203-222. [PMID: 33532137 PMCID: PMC7801276 DOI: 10.14336/ad.2020.0404] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/04/2020] [Indexed: 11/04/2022] Open
Abstract
In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.
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Affiliation(s)
- Chaobo Bai
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongao Wang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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7
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Pai V, Khan I, Sitoh YY, Purohit B. Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist. J Clin Imaging Sci 2020; 10:77. [PMID: 33365199 PMCID: PMC7749941 DOI: 10.25259/jcis_187_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022] Open
Abstract
Dural sinus thrombosis (DST) is a potentially fatal neurological condition that can be reversed with early diagnosis and prompt treatment. Non-enhanced CT scan is often the first imaging investigation in patients presenting with acute neurological symptoms; however, its poor sensitivity in detecting DST is a major drawback. Magnetic resonance (MR) imaging offers multiple advantages such as excellent contrast resolution and unenhanced venography possibilities, making it the mainstay in the non-invasive diagnosis of DST. However, physiological variations, evolution of thrombi, and incorrect selection/application of MR techniques can lead to false positive and false negative interpretations impacting patient management and outcome. This article discusses the MR techniques useful to diagnose DST and describes pitfalls, with troubleshooting methods, to ensure an accurate diagnosis. We have used multiple diagrammatic illustrations and MR images to highlight pertinent take-home points and to serve as an easy guide for day-to-day clinical practice.
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Affiliation(s)
- Vivek Pai
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Iram Khan
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Yih Yian Sitoh
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Bela Purohit
- Department of Neuroradiology, National Neuroscience Institute, Singapore
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Penailillo E, Bravo-Grau S, Plaza N, Cruz JP. Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls. Curr Probl Diagn Radiol 2020; 50:725-733. [PMID: 32950306 DOI: 10.1067/j.cpradiol.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
Cerebral venous thrombosis is a less common but relevant cause of stroke in adults. The clinical manifestations are nonspecific leading frequently diagnostic delays, so imaging findings are is of vital importance. Conventional imaging modalities, namely computed tomography and magnetic resonance imaging (MRI), allow identification of the thrombus and parenchymal involvement due to venous congestion to a variable degree, but this entity may appears as a nonexpected finding in a nonvenographic study. computed tomography and MRI venographies allow noninvasive confirmation of the diagnosis and adequate characterization of the extent of the thrombus and acute complications, both of them being robust diagnostic techniques. MR venography also can be done without the use of contrast media, which is especially important in certain clinical situations. Cerebral venous thrombosis needs follow-up, and imaging plays a key role in detection of late complications of the disease, including dural arteriovenous fistulas and intracranial hypertension due to veno-occlusive disease. Knowledge of other diseases and conditions that may mimic a thrombus is needed to avoid wrong diagnosis. In this article, we conduct a pictorial comprehensive review of cerebral venous thrombosis, including also the technical aspects of different imaging modalities, diagnosis and acute complications, follow-up, late complications and potential imaging mimics.
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Affiliation(s)
- Eduardo Penailillo
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Sebastian Bravo-Grau
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Nicole Plaza
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile
| | - Juan Pablo Cruz
- Department of Radiology, Neuroradiology Section, Pontificia Universidad Catolica de Chile, Santiago Region Metropolitana, Chile.
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Huang YK, Tseng YH, Lin CH, Tsai YH, Hsu YC, Wang SC, Chen CW. Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging. BMC Med Imaging 2019; 19:96. [PMID: 31847822 PMCID: PMC6918566 DOI: 10.1186/s12880-019-0395-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity. Methods This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5 T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications. Results The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9 and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen’s kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft. Conclusion TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV + MRA) in the clinical setting in patients with venous scenarios.
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Affiliation(s)
- Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan
| | - Yin-Chen Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan
| | - Shih-Chung Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan.,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chien-Wei Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan. .,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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10
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Comparative evaluation of dural venous sinuses and cerebral veins using contrast-enhanced spoiled gradient recalled echo and time-of-flight magnetic resonance venography. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.556044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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11
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Zhou D, Ding JY, Ya JY, Pan LQ, Yan F, Yang Q, Ding YC, Ji XM, Meng R. Understanding jugular venous outflow disturbance. CNS Neurosci Ther 2018; 24:473-482. [PMID: 29687619 DOI: 10.1111/cns.12859] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/18/2018] [Indexed: 12/11/2022] Open
Abstract
Extracranial venous abnormalities, especially jugular venous outflow disturbance, were originally viewed as nonpathological phenomena due to a lack of realization and exploration of their feature and clinical significance. The etiology and pathogenesis are still unclear, whereas a couple of causal factors have been conjectured. The clinical presentation of this condition is highly variable, ranging from insidious to symptomatic, such as headaches, dizziness, pulsatile tinnitus, visual impairment, sleep disturbance, and neck discomfort or pain. Standard diagnostic criteria are not available, and current diagnosis largely depends on a combinatory use of imaging modalities. Although few researches have been conducted to gain evidence-based therapeutic approach, several recent advances indicate that intravenous angioplasty in combination with stenting implantation may be a safe and efficient way to restore normal blood circulation, alleviate the discomfort symptoms, and enhance patients' quality of life. In addition, surgical removal of structures that constrain the internal jugular vein may serve as an alternative or adjunctive management when endovascular intervention is not feasible. Notably, discussion on every aspect of this newly recognized disease entity is in the infant stage and efforts with more rigorous designed, randomized controlled studies in attempt to identify the pathophysiology, diagnostic criteria, and effective approaches to its treatment will provide a profound insight into this issue.
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Affiliation(s)
- Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Yue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing-Yuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-Qun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Yan
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xun-Ming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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