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Ogul H, Ay M. Abnormal progression of brain herniation into intraosseous arachnoid granulation in a patient with metastatic lung carcinoma. Acta Neurol Belg 2024; 124:1151-1154. [PMID: 38698186 DOI: 10.1007/s13760-024-02566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Hayri Ogul
- Department of Radiology, Medical Faculty, Duzce University, Duzce, Turkey.
| | - Mutlu Ay
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Guevara Tirado OA, Mertiri L, Kralik SF, Desai NK, Huisman TAGM, Lequin MH, Tran H(BD. Neuroimaging of Vermiform Giant Arachnoid Granulations in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:763. [PMID: 39062213 PMCID: PMC11275230 DOI: 10.3390/children11070763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Arachnoid granulations (AGs) are generally benign structures within the subarachnoid space that extend into the dural sinuses and calvarial bone. They can present in a variety of sizes but are termed 'giant' arachnoid granulations (GAGs) when they are larger than 1 cm in diameter or take up a significant portion of the dural sinus' lumen. Vermiform giant arachnoid granulations are a specific type of GAG that are known for their worm-like appearance. Specifically, these vermiform GAGs can be challenging to diagnose as they can mimic other pathologies like dural sinus thrombosis, sinus cavernomas, or brain tumors. In this case series, we present two cases of vermiform giant arachnoid granulations, discuss their imaging characteristics and highlight the diagnostic challenges to improve identification and prevent misdiagnoses.
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Affiliation(s)
- Oswaldo A. Guevara Tirado
- Ponce Health Sciences University School of Medicine, 388 Zona Industrial Reparada 2, Ponce, PR 00716, USA;
| | - Livja Mertiri
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
| | - Stephen F. Kralik
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
| | - Nilesh K. Desai
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
| | - Thierry A. G. M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
| | - Maarten H. Lequin
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
| | - Huy (Brandon) D. Tran
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA; (L.M.); (S.F.K.); (N.K.D.); (T.A.G.M.H.); (M.H.L.)
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Tan AP, Rasheed S, Sidpra J, Lim MC, James G, Oztekin O, Gonçalves FG, Mankad K. An algorithmic clinicoradiological approach to paediatric cranial vault lesions: distinguishing normal variants from pathologies. Br J Neurosurg 2023; 37:986-999. [PMID: 33960863 DOI: 10.1080/02688697.2021.1919599] [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: 03/08/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Lesions of the paediatric cranial vault are diverse both in their presentation and aetiology. As such, they pose a diagnostic challenge to the paediatric neurosurgeon and neuroradiologist. In this article, we delineate the spectrum of paediatric calvarial pathology into four distinct groups: (1) lytic lesion(s); (2) focal sclerotic lesion(s); (3) diffuse cranial vault sclerosis; and (4) abnormal shape of the cranial vault. It is our aim that this more pragmatic, algorithmic approach may mitigate diagnostic uncertainty and aid the more accurate diagnosis of paediatric calvarial lesions.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Shabana Rasheed
- Department of Diagnostic Imaging, KK Children and Women's Hospital, Singapore, Singapore
| | - Jai Sidpra
- Developmental Biology and Cancer Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Mei Chin Lim
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ozgur Oztekin
- Department of Neuroradiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | | | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Kaplanoğlu V, Kaplanoğlu H, Turan A, Dilli A. Evaluation of Arachnoid Granulations in Cranial Dural Sinuses with Contrast-Enhanced 3-Dimensional T1-Weighted Magnetic Resonance Imaging. Eurasian J Med 2023; 55:95-99. [PMID: 37403905 PMCID: PMC10440968 DOI: 10.5152/eurasianjmed.2023.22104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/23/2022] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Several studies in the literature have used contrast-enhanced magnetic resonance imaging to investigate arachnoid granulations protruding into the cranial dural sinuses. The current study aimed to investigate the protrusion of arachnoid granulations into the superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses and determine the frequency of brain herniation into giant arachnoid granulations using contrast-enhanced 3-dimensional T1-weighted magnetic resonance imaging. MATERIALS AND METHODS Images of 550 patients with intra-sinus arachnoid granulations who underwent contrast-enhanced 3-dimensional T1-weighted thin-slice magnetic resonance imaging were retrospectively re-evaluated. Only 300 patients with at least 1 intra-sinus arachnoid granulation were included in the study. The protrusion of arachnoid granulations into superior sagittal sinus, transverse sinus, straight sinus, and confluence of sinuses was investigated. In addition, large arachnoid granulations and brain herniations into arachnoid granulations were also noted. RESULTS A total of 889 focal filling defects of arachnoid granulations, at least 1 in the dural sinus, were detected. Of the filling defects of arachnoid granulations, 183 were in the right transverse sinus, 222 in the left transverse sinus, 265 in superior sagittal sinus, 185 in straight sinus, and 34 in confluence of sinuses. Brain herniation into arachnoid granulations was detected in 8 (2.7%) of the patients included in the study. All the filling defects detected in the dural sinuses on post-contrast 3-dimensional T1-weighted images were isointense with cerebrospinal fluid and had round, oval, or lobulated contours. A positive weak correla- tion was found between patient age and the size and number of arachnoid granulations (r = 0.181, P < .01 and r=0.207, P < .001, respectively). It was observed that the size and number of arachnoid granulations increased as the age of the patients increased. CONCLUSIONS The distribution, shape, number, and size of intra-sinus arachnoid granulations can vary considerably. Brain herniation into arachnoid granulation can also be seen. Three-dimensional cranial magnetic resonance imaging sequences can be safely used in the evaluation of arachnoid granulations.
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Affiliation(s)
- Veysel Kaplanoğlu
- Department of Radiology, University of Health Sciences, Atatürk Sanatory Training and Research Hospital, Ankara, Turkey
| | - Hatice Kaplanoğlu
- Department of Radiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkiye
| | - Aynur Turan
- Department of Radiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkiye
| | - Alper Dilli
- Department of Radiology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkiye
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Zhang M, Shi B, Zhao M. Cerebral venous thrombosis with hyperhomocysteinemia due to loss of heterozygosity at methylenetetrahydrofolate reductase (MTHFR) locus: a case report. BMC Neurol 2023; 23:154. [PMID: 37076800 PMCID: PMC10114475 DOI: 10.1186/s12883-023-03200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Loss of heterozygosity (LOH) at methylenetetrahydrofolate reductase (MTHFR) locus has been reported in tumor tissue. But the mutation was never reported in cerebral venous thrombosis (CVT) with hyperhomocysteinemia (HHcy) before. CASE PRESENTATION A 14-year-old girl was admitted with an intermittent headache and nausea for 2 months. The plasma homocysteine level was 77.2 µmol/L. Lumbar puncture revealed an intracranial pressure > 330 mmH2O. Cerebral MRI and MRV revealed superior sagittal sinus thrombosis. Whole-exome sequencing revealed LOH at Chr1:11836597-11,867,232 affects exons 10-21 of C1orf167, the entire MTHFR, and exons 1-2 of the CLCN6 gene. The normal allele was the c.665 C > T/677 C > T variant in MTHFR. The patient was treated with nadroparin for 2 weeks, followed by oral rivaroxaban. Supplemental folate and vitamins B12 and B6 were prescribed. One month later, she had no headache and the intracranial pressure had decreased to 215 mmH2O. MRI showed shrinkage of the thrombosis in the superior sagittal sinus, the degree of stenosis had significantly decreased. CONCLUSIONS Rare LOH at the MTHFR locus should be analyzed in CVT with HHcy. With anticoagulation treatment, the prognosis was good.
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Affiliation(s)
- Mingjie Zhang
- Department of Neurology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, PR China
| | - Bingxin Shi
- Brain Science Center, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Beijing, 100049, PR China
| | - Mangsuo Zhao
- Brain Science Center, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Beijing, 100049, PR China.
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The controversial entity of brain herniations into arachnoid granulations: A report of three cases with literature review. Radiol Case Rep 2021; 16:2768-2773. [PMID: 34367392 PMCID: PMC8326588 DOI: 10.1016/j.radcr.2021.06.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/21/2022] Open
Abstract
Brain herniation into arachnoid granulation (BHAG) is a quite recently described controversial entity in terms of both etiology and clinical significance. It comprises a herniation of brain tissue into a presumed preexisting arachnoid granulation in dural venous sinuses, calvarium, meningeal or diploic veins. Most often described as an incidental finding in patients examined for unrelated pathologies, some BHAGs can possibly be related to headache, epilepsy or conditions with increased intracranial pressure such as idiopathic intracranial hypertension (IIH) or pseudotumor cerebri (PTC). The number of reported cases is low and there are only three more recently published observational studies on this subject with results lacking statistical significance due to relatively few BHAGs analyzed. Therefore, BHAGs still need an increased focus from both the radiologists and clinicians and more published studies and cases are necessary to help in understanding their factual meaning, clinical and treatment implications. In this article we describe three new cases of BHAGs to the literature, with patients presenting with different symptoms.
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Gozgec E, Ogul H, Izgi E, Kantarci M. Tissue damage in herniated brain parenchyma into giant arachnoid granulations: demonstration with high resolution MRI. Acta Radiol 2021; 62:799-806. [PMID: 32686459 DOI: 10.1177/0284185120941829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brain herniation (BH) into arachnoid granulation has been remarkable in recent years. PURPOSE To evaluate the damage in herniated parenchyma into the giant arachnoid granulation (GAG) and to investigate the clinical-demographic importance of this damage. MATERIAL AND METHODS Patients with BH into GAG were retrospectively included in the study. Each of the patients had at least one high-resolution 3D magnetic resonance imaging (MRI) sequence. The arachnoid granulation dimensions, locations, and origin of herniated parenchyma were evaluated by two experienced radiologists. The demographic and symptomatic features of the patients were recorded from the hospital database. RESULTS A total of 27 patients (21 females, 6 males; age range 6-71 years; mean age 41.3 years) were found to contain BH into GAG. It was most commonly seen in the transverse sinus (67%); the origin was most common in the cerebellar parenchyma (56%). Abnormal signal and morphology were detected in herniated parenchyma in 11 (47%) patients, atrophy in six, and atrophy and gliosis in five. The most common complaints were headache (47%), while other frequent symptoms were vertigo (15%) and blurred vision (11%). There was a statistically significant positive correlation between frequency of damage in herniated brain parenchyma and the maximal size of GAG (P<0.05). CONCLUSION In patients with BH into GAG, parenchymal damage may be associated with various symptoms, such as headache and vertigo, although they have not been statistically proven. It is important to carefully evaluate hernia tissue, as the risk of tissue damage may increase in larger GAGs.
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Affiliation(s)
- Elif Gozgec
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
- Department of Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Emine Izgi
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Tsutsumi S, Ono H, Ishii H. Arachnoid granulations bulging into the transverse sinus, sigmoid sinus, straight sinus, and confluens sinuum: a magnetic resonance imaging study. Surg Radiol Anat 2021; 43:1311-1318. [PMID: 33635406 DOI: 10.1007/s00276-021-02719-4] [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: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Few studies have explored arachnoid granulations (AGs) bulging into the cranial dural sinuses using contrast-enhanced magnetic resonance imaging (MRI). This study aimed to explore such AGs in the transverse (TS), sigmoid (SigS), and straight (StS) sinuses, and confluens sinuum (ConfS) using thin-sliced, contrast MRI. METHODS A total of 102 patients with intact dural sinuses underwent thin-sliced, contrast MRI in the axial, coronal, and sagittal planes. RESULTS In 88.2%, more than one AG was identified in the TS and SigS, StS, and ConfS. In the TS, AGs were identified in 40.2% on the right side and 37.3% on the left and were frequently located in the middle and lateral thirds. In the SigS, AGs were identified on the right in 17.6% and on the left in 18.6% in the distal region. In the StS, AGs were identified in 35.3% of cases, most frequently located in the proximal third, followed by the distal third. In the ConfS, AGs were identified in 20.6% of cases. Furthermore, in 23.5%, a collection of multiple AGs of varying sizes was found in the TS. A statistical difference was not shown between the mean age of 90 patients with AGs and that of 12 patients without identifiable AGs. CONCLUSIONS Bulging AGs may more frequently found in the TS. Thin-sliced, contrast MRI is useful for delineating AGs.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Abstract
Cerebral venous thrombosis (CVT) is a rare form of deep venous thrombosis (DVT), yet a leading cause of stroke in young adults, with an incidence that seems to be increasing in recent years. Risk factors for CVT overlap with those of DVT in other locations, with the addition of local risk factors, such as infections, head trauma and neurosurgery. The clinical presentation is highly variable, hence the diagnosis of CVT may be delayed or overlooked. Early recognition and timely initiation of anticoagulant treatment are of essence, while decompressive surgery can be lifesaving for patients with impending transtentorial herniation. Concomitant intracranial hemorrhage is not a contraindication to anticoagulant treatment. Endovascular treatment may be suggested for selected patients who deteriorate despite anticoagulant treatment. In this review we will provide an extensive and contemporary discussion of the incidence, pathophysiology, risk factors, clinical presentation, neuroimaging and management of CVT, in accordance with recent guidelines. Additionally, we will summarize the latest data with regards to direct oral anticoagulants (DOACs) treatment in CVT.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel - .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel - .,Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| | - Samuela Pegoraro
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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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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Lv B, Tian CL, Cao XY, Liu XF, Wang J, Yu SY. Role of diffusion-weighted imaging in the diagnosis of cerebral venous thrombosis. J Int Med Res 2020; 48:300060520933448. [PMID: 32589072 PMCID: PMC7323280 DOI: 10.1177/0300060520933448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/20/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the hyperintense signal (HIS) performance on diffusion-weighted imaging (DWI) in diagnosing cerebral venous thrombosis (CVT). METHODS Seventy-eight patients with CVT hospitalized from January 2004 to January 2015 were retrospectively studied alongside 78 controls without intracranial organic diseases. Diagnostic accuracy indices of HIS on DWI or T2-weighted imaging (T2WI) to diagnose CVT at different sites and states were analyzed. RESULTS The overall sensitivity of HIS on DWI for the diagnosis of CVT was significantly lower than that of HIS on T2WI (34.6% vs. 79.5%). HIS on T2WI was more sensitive than HIS on DWI in detecting thrombosis, especially in the superior sagittal sinus and transverse sinus. HIS on DWI was inversely related to the time between disease onset and imaging. Compared with HIS on T2WI, combining HIS on DWI and T2WI did not increase the sensitivity for detecting CVT. HIS on DWI was not detected in the control group, but HIS on T2WI was detected in 26.3% of control individuals. The specificity of HIS on DWI for CVT was higher than that of HIS on T2WI (97.4% vs. 76.9%). CONCLUSION HIS on DWI has a lower sensitivity, but a higher specificity, than HIS on T2WI for diagnosing CVT.
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Affiliation(s)
- Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiang-yu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin-feng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sheng-yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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12
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Ogul H, Guven F, Izgi E, Kantarci M. Evaluation of giant arachnoid granulations with high-resolution 3D-volumetric MR sequences at 3T. Eur J Radiol 2019; 121:108722. [DOI: 10.1016/j.ejrad.2019.108722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/17/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
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Mamaliga T, Hadi M. An unusual vermiform giant arachnoid granulation. Radiol Case Rep 2019; 14:1525-1528. [PMID: 31709020 PMCID: PMC6831846 DOI: 10.1016/j.radcr.2019.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 12/22/2022] Open
Abstract
Arachnoid granulations are outpouchings of arachnoid membrane which extend into the dural sinuses or calvarium, surrounded by a capsule of dense connective tissue. Within dural sinuses, these appear as well-defined, nodular, rounded, or ovoid structures of focal localization. However, it is important to be aware of their variability in presentation in order to correctly identify them and distinguish them from other dural sinus pathology, especially a misdiagnosis of venous sinus thrombosis with risks of unnecessary anticoagulation, intravascular thrombolysis/thrombectomy, or invasive intracranial pressure monitoring. Here we demonstrate a case of a previously unreported giant intrasinus arachnoid granulation of an unusual vermiform morphology, unduly elongated up to 6 cm in length, involving a significant segment of the superior sagittal sinus. The proof of this diagnosis was the radiologic appearance on multiple modalities and an unchanged appearance over the long-term.
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Affiliation(s)
- Tatiana Mamaliga
- Medical student, University of Louisville School of Medicine, 530 S Jackson Street, Louisville, KY, 40205, USA
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson Street, Louisville, KY, 40205, USA
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Chitterman A, Warner T, Mehta K, Iwanaga J, Loukas M, Tubbs RS. Ectopic arachnoid granulations: A review. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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15
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A Preliminary Study of Neonatal Cranial Venous System by Color Doppler. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7569479. [PMID: 31183374 PMCID: PMC6512013 DOI: 10.1155/2019/7569479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
Abstract
Aim To present anatomic data in the ultrasound planes for the identification of the major veins and the venous sinuses in cerebrum and to establish the sonographic normal reference values for the visualization of vein vessels and vein sinuses and blood flow velocities. Methods This study involved 55 healthy full-term neonates for transfontanellar color Doppler sonography. The imaging included both sagittal and coronal planes with LA332E probe, supplemented with PA240 probe as necessary. As low as reasonably achievable (ALARA) principle was obeyed, limiting Doppler exposure time and maximizing signal intensity by increasing gain rather than outputting transducer power settings. The output power was kept at a minimum level consistent with recording an adequate signal. Keeping the newborns in calm state, the total examination time which every neonate required was less than 5 min. All images were stored also in a workstation for further analysis. The description statistics and t-test for statistical analysis were used. Result In all studied cases (100% cases), subependymal veins (SV), internal cerebral veins (ICV), Galen vein (GV), straight sinus (SS), superior sagittal sinus (SSS), and transverse sinuses (TS) were visualized. The visualization percentages of inferior sagittal sinus (ISS) or basal veins/Rosenthal veins (BV/RV) were lower than 100%. Based on vessel visualization percentage from high to low, the vessels were ordered as follows: SV, ICV, BV, SS, TS, ISS, and SSS. In SSS and TS, the pulsation percentage was 100%. The descending percentages of vessel pulsation were noted in SS, BV, ICV, and SV. On the basis of the mean of maximum velocities of the vessels from low to high, the vessels were ordered as follows: ISS, BV-L, BV-R, ICV-R, ICV-L, SV-L, SV-R, SSS, TS-L, TS-R, and SS. Conclusion The measurements percent of visualization of cerebral deep veins was higher than the percent of cerebral venous sinuses. The pulsation percent of measurement and the velocities of cerebral venous sinuses were absolutely higher than the cerebral deep venous system. The pairs of vascular blood flow velocities were nonsignificantly different from one another.
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Park SH, Park KS, Hwang JH. Arachnoid Granulations Mimicking Multiple Osteolytic Bone Lesions in the Occipital Bone. Brain Tumor Res Treat 2018; 6:68-72. [PMID: 30381919 PMCID: PMC6212694 DOI: 10.14791/btrt.2018.6.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/16/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022] Open
Abstract
We report a rare case of arachnoid granulations mimicking multiple osteolytic bone lesions. A 66-year-old woman was admitted to a local clinic for a regular checkup. Upon admission, brain CT showed multiple osteolytic lesions in the occipital bone. These needed to be differentiated from multiple osteolytic bone tumor. Subsequent brain MRI revealed that the osteolytic lesions were isointense to cerebrospinal fluid, hyperintense on T2-weighted image, hypointense on T1-weighted image, and with subtle capsules around the osteolytic lesions that were visible after gadolinium injection. A bone scan revealed no radiotracer uptake. The lesions were in both the transverse sinuses and the torcular herophili. With typical radiological appearances of the lesions, the osteolytic lesions were diagnosed as multiple arachnoid granulations. No further treatment was planned. A 1-year follow-up brain CT scan revealed no change. We should consider the possibility of arachnoid granulations when multiple osteolytic lesions are observed in the occipital bone.
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Affiliation(s)
- Seong Hyun Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
| | - Ki Su Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jeong Hyun Hwang
- Department of Neurosurgery, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
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Abstract
Cerebral venous thrombosis (CVT) is an important cause of stroke in young adults. Data from large international registries published in the past two decades have greatly improved our knowledge about the epidemiology, clinical manifestations and prognosis of CVT. The presentation of symptoms is highly variable in this disease, and can range from a patient seen at the clinic with a 1-month history of headache, to a comatose patient admitted to the emergency room. Consequently, the diagnosis of CVT is often delayed or overlooked. A variety of therapies for CVT are available, and each should be used in the appropriate setting, preferably guided by data from randomized trials and well-designed cohort studies. Although deaths from CVT have decreased in the past few decades, mortality remains ∼5-10%. In this Review, we provide a comprehensive and contemporary overview of CVT in adults, with emphasis on advancements made in the past decade on the epidemiology and treatment of this multifaceted condition.
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Affiliation(s)
- Suzanne M Silvis
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal
| | - José M Ferro
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Brain Herniation into Giant Arachnoid Granulation: An Unusual Case. Case Rep Radiol 2017; 2017:8532074. [PMID: 28392955 PMCID: PMC5368369 DOI: 10.1155/2017/8532074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 11/17/2022] Open
Abstract
Arachnoid granulations are structures filled with cerebrospinal fluid (CSF) that extend into the venous sinuses through openings in the dura mater and allow the drainage of CSF from subarachnoid space into venous system. Usually they are asymptomatic but can be symptomatic when large enough to cause sinus occlusion. We report a rare case of a brain herniation into a giant arachnoid granulation in an asymptomatic elderly male patient, which was discovered incidentally.
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Umeh R, Oskouian RJ, Loukas M, Tubbs RS. Giant Arachnoid Granulation Associated with Anomalous Draining Vein: A Case Report. Cureus 2017; 9:e1065. [PMID: 28409066 PMCID: PMC5375954 DOI: 10.7759/cureus.1065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant arachnoid granulations (AG) can mimic intracranial lesions. Knowledge of these structures can help avoid misdiagnosis when interpreting imaging. Here, we report a child who presented with a mass within the superior sagittal sinus and an anomalous draining vein. Herein, the diagnosis of a giant AG was made. Clinicians who view or interpret imaging of the head should be aware of these anatomical variants and though when very large, apparently, do not necessarily result in pathology. Based on our case report, giant AG might also demonstrate anomalous draining veins.
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Affiliation(s)
- Randle Umeh
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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22
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Liebo GB, Lane JJI, Van Gompel JJ, Eckel LJ, Schwartz KM, Lehman VT. Brain Herniation into Arachnoid Granulations: Clinical and Neuroimaging Features. J Neuroimaging 2016; 26:592-598. [DOI: 10.1111/jon.12366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Greta B. Liebo
- Department of Radiology; Mayo Clinic-Rochester; Rochester MN
| | | | - Jamie J. Van Gompel
- Department of Neurologic Surgery and Otolaryngology; Mayo Clinic-Rochester; Rochester MN
| | | | | | - Vance T. Lehman
- Department of Radiology; Mayo Clinic-Rochester; Rochester MN
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23
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Mokin M, Ciambella CC, Masud MW, Levy EI, Snyder KV, Siddiqui AH. Whole-Brain Computed Tomographic Perfusion Imaging in Acute Cerebral Venous Sinus Thrombosis. INTERVENTIONAL NEUROLOGY 2016; 4:104-12. [PMID: 27051406 DOI: 10.1159/000442717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Acute cerebral venous sinus thrombosis (VST) can be difficult to diagnose because of its diverse clinical presentation. The utility of perfusion imaging for diagnosing VST is not well understood. SUMMARY We retrospectively reviewed cases of acute VST in patients who underwent whole-brain (320-detector-row) computed tomographic (CT) perfusion imaging in combination with craniocervical CT venography. Perfusion maps that were analyzed included cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time, and time to peak. Among the 10 patients with acute VST included in this study, 9 had perfusion abnormalities. All perfusion abnormalities were localized in areas adjacent to the occluded sinus and did not match typical anterior or posterior circulation arterial territories. Bilateral perfusion deficits were seen in 4 cases. In 2 cases, parenchymal hemorrhage was diagnosed on noncontrast CT imaging; in those cases, focal CBV and CBF were reduced. KEY MESSAGES Whole-brain CT perfusion imaging with 320-detector-row scanners can further assist in establishing the diagnosis of VST by detecting perfusion abnormalities corresponding to venous and not arterial territories. CT perfusion could assist in the differentiation between focal reversible changes, such as those caused by vasogenic edema, and irreversible changes due to infarction.
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Affiliation(s)
- Maxim Mokin
- Departments of Neurosurgery, School of Medicine and Biomedical Sciences USA; Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, N.Y., USA
| | - Chelsey C Ciambella
- Departments of Neurosurgery, School of Medicine and Biomedical Sciences USA; Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, N.Y., USA
| | - Muhammad W Masud
- Departments of Neurology, School of Medicine and Biomedical Sciences USA
| | - Elad I Levy
- Departments of Neurosurgery, School of Medicine and Biomedical Sciences USA; Departments of Radiology, School of Medicine and Biomedical Sciences, USA; Departments of Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, N.Y., USA
| | - Kenneth V Snyder
- Departments of Neurosurgery, School of Medicine and Biomedical Sciences USA; Departments of Neurology, School of Medicine and Biomedical Sciences USA; Departments of Radiology, School of Medicine and Biomedical Sciences, USA; Departments of Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, N.Y., USA
| | - Adnan H Siddiqui
- Departments of Neurosurgery, School of Medicine and Biomedical Sciences USA; Departments of Radiology, School of Medicine and Biomedical Sciences, USA; Departments of Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, N.Y., USA; Jacobs Institute, Buffalo, N.Y., USA
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Selvitop O, Poretti A, Huisman TA, Wagner MW. Cerebral sinovenous thrombosis in a child with Crohn's disease, otitis media, and meningitis. Neuroradiol J 2015; 28:274-7. [PMID: 26246095 DOI: 10.1177/1971400915589688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric cerebral sinovenous thrombosis (CSVT) is associated with high morbidity and mortality. Severe long-term sequelae are reported in up to 48% of children. The most frequent location of CSVT in children is the superficial venous system. We present the neuroimaging findings using both computed tomography and magnetic resonance imaging (MRI) in a 10-year-old child with extensive superficial CSVT. Our report aims to stress the importance of awareness of risk factors in suspecting and rapidly diagnosing CSVT. The application of targeted conventional and advanced MRI sequences is the diagnostic tool of choice in children at risk of or with clinically suspected CSVT.
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Affiliation(s)
- Omer Selvitop
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Poretti
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thierry Agm Huisman
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthias W Wagner
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Tsutsumi S, Ogino I, Miyajima M, Ito M, Arai H, Yasumoto Y. Cerebrospinal fluid drainage through the diploic and spinal epidural veins. J Anat 2015; 227:297-301. [PMID: 26184099 DOI: 10.1111/joa.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to quantitatively evaluate the function of the cranial diploic and spinal epidural veins as cerebrospinal fluid (CSF) drainage pathways by measuring lipocalin-type prostaglandin D synthase (PGDS) and cystatin C (CysC) dissolved in the blood of these veins. This was a prospective study involving 51 consecutive patients, 31 males and 20 females, who underwent 41 cranial and 10 spinal surgeries. Intraoperatively, peripheral venous blood and diploic venous blood, or peripheral venous blood and spinal epidural venous blood samples were simultaneously collected and immediately centrifuged. For all samples, dissolved albumin (for reference), PGDS and CysC were measured using an enzyme-linked immunosorbent assay. The diploic vein/peripheral vein ratios in five cranial locations and epidural vein/peripheral vein ratios were calculated and statistically evaluated for the three biomarkers. For PGDS, the diploic vein/peripheral vein ratio was significantly increased in the frontal (P = 0.011), temporal (P = 0.028), parietal (P = 0.046) and skull base (P = 0.039), while it did not reach statistical significance for CysC. For patients older than 45 years, the diploic vein/peripheral vein ratio for PGDS was significantly decreased in the frontal region (P = 0.028), and the epidural vein/peripheral vein ratio for CysC was significantly decreased (P = 0.014). These results show that the diploic veins constitute CSF drainage pathways with heterogeneous functional intensity at different cranial locations. Compared with the diploic veins, spinal epidural veins seem to drain less CSF. The cranial diploic and spinal epidural veins may jointly function as an alternative, age-related trans-dural CSF drainage system.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Ikuko Ogino
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masanori Ito
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hajime Arai
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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26
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De Keyzer B, Bamps S, Van Calenbergh F, Demaerel P, Wilms G. Giant arachnoid granulations mimicking pathology. A report of three cases. Neuroradiol J 2014; 27:316-21. [PMID: 24976198 DOI: 10.15274/nrj-2014-10047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/16/2014] [Indexed: 11/12/2022] Open
Abstract
We describe three cases of incidentally found lesions in the dural venous sinuses on magnetic resonance imaging, that other had erroneously considered pathological entities. We made the diagnosis of giant arachnoid granulations. The differential diagnosis with thrombosis or intrasinusal tumoral lesions was easily made on the basis of three typical radiological features of the granulations: the hyperintensity of the lesions on FLAIR, a blood vessel within the lesion and bone erosion.
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Affiliation(s)
- Bart De Keyzer
- Department of Radiology, UZ Leuven, Campus Gasthuisberg; Leuven, Belgium -
| | - Sven Bamps
- Department of Radiology, UZ Leuven, Campus Gasthuisberg; Leuven, Belgium
| | | | - Philippe Demaerel
- Department of Radiology, UZ Leuven, Campus Gasthuisberg; Leuven, Belgium
| | - Guido Wilms
- Department of Radiology, UZ Leuven, Campus Gasthuisberg; Leuven, Belgium
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27
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Tsutsumi S, Ogino I, Miyajima M, Nakamura M, Yasumoto Y, Arai H, Ito M. Cranial arachnoid protrusions and contiguous diploic veins in CSF drainage. AJNR Am J Neuroradiol 2014; 35:1735-9. [PMID: 24948506 DOI: 10.3174/ajnr.a4007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Studies have suggested that arachnoid villi or granulations found in the walls of the cranial dural sinuses, olfactory mucosa, and cranial nerve sheaths function as outlets for intracranial CSF. However, their role as CSF outlets has not yet been verified. Here we show that arachnoid protrusions and contiguous diploic veins provide an alternative drainage route for intracranial CSF. MATERIALS AND METHODS Four hundred patients with intact skull, dura mater, and dural sinuses underwent MR imaging to explore arachnoids protruding into the skull and diploic veins. Patients with symptoms of increased intracranial pressure or intracranial hypotension were excluded. For 15 patients undergoing craniotomy, both peripheral and diploic venous blood was collected. Albumin and the CSF-specific biomarkers were measured by enzyme-linked immunosorbent assay. RESULTS With MR imaging, arachnoid protrusions into the skull and contiguous diploic veins were consistently identified throughout the cranium with their characteristic appearance depending on the cranial region. In addition, elevated amounts of prostaglandin D synthase and cystatin C were confirmed in diploic veins compared with peripheral venous blood. CONCLUSIONS Diploic veins are distributed ubiquitously throughout the cranium. A portion of the intracranial CSF may be drained through arachnoid protrusions and contiguous diploic veins.
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Affiliation(s)
- S Tsutsumi
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
| | - I Ogino
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Miyajima
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Nakamura
- Division of Radiological Technology (M.N.), Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Y Yasumoto
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
| | - H Arai
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Ito
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
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Bracken J, Barnacle A, Ditchfield M. Potential pitfalls in imaging of paediatric cerebral sinovenous thrombosis. Pediatr Radiol 2013; 43:219-31. [PMID: 22948810 DOI: 10.1007/s00247-012-2402-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 01/01/2012] [Accepted: 01/15/2012] [Indexed: 11/24/2022]
Abstract
Paediatric cerebral sinovenous thrombosis (CSVT) is a rare but serious condition. The imaging signs may be subtle with a number of potential pitfalls. We present a pictorial essay of the pitfalls of diagnosis of CSVT on CT and MRI. We describe, using examples, potential pitfalls on both imaging modalities including anatomical variants of the cerebral venous system, extra-axial fluid collections and enhancement of chronic thrombus. Pitfalls particular to CT are discussed including beam-hardening artefact, image windowing and neonatal physiological intravascular hyperdensity. We review the potential variability in the appearance of thrombus on MRI, dependent largely on the stage of thrombus evolution and the pulse sequence. The signal intensity of thrombi, although described as evolving in a typical pattern on T1- and T2-weighted MRI, may be affected by variability in the degree of oxygenation of red cells in the forming thrombus, dilution and secondary propagation of thrombosis. Individual MRI sequences should not be interpreted in isolation, but as a set, and compared with CT images if available.
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Affiliation(s)
- Jennifer Bracken
- Department of Medical Imaging, Monash Children's Hospital, 246 Clayton Road, Clayton, Victoria 3168, Australia.
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Lu CX, Du Y, Xu XX, Li Y, Yang HF, Deng SQ, Xiao DM, Li B, Tian YH. Multiple occipital defects caused by arachnoid granulations: Emphasis on T2 mapping. World J Radiol 2012; 4:341-4. [PMID: 22900137 PMCID: PMC3419866 DOI: 10.4329/wjr.v4.i7.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/23/2012] [Accepted: 06/30/2012] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old man presented with a 6-mo history of headache. Although neurological and laboratory examinations were normal, computed tomography (CT) scan was performed which revealed multiple occipital osteolytic lesions, which were suspected to be multiple myeloma. Subsequently nuclear magnetic resonance imaging (MRI) showed that these lesions presented with a cerebrospinal fluid (CSF)-like signal intensity, no diffusional restriction and intrinsic mass-like enhancement on conventional sequences were seen. T2 relaxation time was similar to that of CSF in the ventricles and adjacent subarachnoid space on T2-mapping. Single photon emission CT with 99mTc-Methyl diphosphonate was performed which revealed no increased radiotracing accumulation. Finally, these lesions were diagnosed as mutiple arachnoid granulations (AGs). The headache was treated symptomatically with medical therapy. On follow up examination after 6 mo no evidence of tumor was detected. This report aimed to illustrate the appearance and differentiation of occipital defects caused by multiple AGs on CT and MRI, with emphasis on the findings from T2 mapping.
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Hingwala D, Chatterjee S, Kesavadas C, Thomas B, Kapilamoorthy TR. Applications of 3D CISS sequence for problem solving in neuroimaging. Indian J Radiol Imaging 2011; 21:90-7. [PMID: 21799590 PMCID: PMC3137865 DOI: 10.4103/0971-3026.82283] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Three-dimensional (3D) constructive interference in steady state (CISS) is a gradient-echo MRI sequence that is used to investigate a wide range of pathologies when routine MRI sequences do not provide the desired anatomic information. The increased sensitivity of the 3D CISS sequence is an outcome of the accentuation of the T2 values between cerebrospinal fluid (CSF) and pathological structures. Apart from its well-recognized applications in the evaluation of the cranial nerves, CSF rhinorrhea and aqueduct stenosis, we have found the CISS sequence to be useful for the cisternal spaces, cavernous sinuses and the ventricular system, where it is useful for detecting subtle CSF-intensity lesions that may be missed on routine spin-echo sequences. This information helps in the management of these conditions. After a brief overview of the physics behind this sequence, we illustrate its clinical applications with representative cases and discuss its potential role in imaging protocols.
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Affiliation(s)
- Divyata Hingwala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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31
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Chan WC, Lai V, Wong YC, Poon WL. Focal brain herniation into giant arachnoid granulation: A rare occurrence. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2011.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trimble CR, Harnsberger HR, Castillo M, Brant-Zawadzki M, Osborn AG. "Giant" arachnoid granulations just like CSF?: NOT!! AJNR Am J Neuroradiol 2010; 31:1724-8. [PMID: 20581064 DOI: 10.3174/ajnr.a2157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
"Giant" AGs (>1 cm) are uncommon and can be misdiagnosed as venous sinus pathology such as a neoplasm or thrombosis. Seventeen patients with a total of 19 venous sinus AGs of >1 cm were collected from contributing authors. MR imaging was available for all AGs; CT, for 5/19; and DSA, for 7/19. Intra-AG fluid was compared with CSF in subarachnoid spaces. Nonfluid AG tissue was compared with gray matter. Diagnosis was based on imaging findings. Fluid within giant AGs did not follow CSF signal intensity on at least 1 MR image in nearly 80% (15/19) of AGs. Nine of these 15 AGs had CSF-incongruent signal intensity on ≥2 MR images. CSF-incongruent signal intensity was seen in 8/8 AGs on FLAIR, 7/10 on precontrast T1WI, 13/19 on T2WI, and 8/14 on contrast-enhanced T1WI. Nonfluid signal intensity was present in 18/19 AGs and varied from absent/hypointense (intra-AG flow voids) to gray matter isointense (stromal tissue).
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Affiliation(s)
- C R Trimble
- Department of Radiological Sciences, Irvine Medical Center, University of California-Irvine, 101 The City Drive, Orange, CA 92868, USA.
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