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Rai Y, Ogiwara H. Atretic cephalocele associated with sinus pericranii: a single-center analysis. Childs Nerv Syst 2024; 40:543-547. [PMID: 37480523 DOI: 10.1007/s00381-023-06067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/05/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The purpose of this report is to investigate the association of atretic cephalocele (AC) with sinus pericranii (SP) in order to improve the management of AC. METHODS Pediatric patients with AC who underwent repair surgeries were retrospectively analyzed. Anomalies including SP were evaluated using computed tomography angiography and venography (CTA/V) as well as magnetic resonance imaging. RESULTS Fourteen patients were identified, comprising of 5 males and 9 females. The AC was located interparietally in 8 cases and occipitally in 6 cases. Seven cases (50%) were found to be associated with SP, all of which did not involve major intracranial venous circulation. Five out of 8 parietal ACs (63%) were accompanied by SP, while 2 out of 6 occipital ACs (33%) exhibited SP. All of the SP associated with AC only contributed to a small portion of the venous outflow, and the repair surgeries were successfully performed without excessive bleeding. CONCLUSION More than half of the ACs were associated with SP, with a higher prevalence in the parietal region compared to the occipital region. For the appropriate management of AC, preoperative investigation of SP using CT venography is considered important.
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Affiliation(s)
- Yurie Rai
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, Japan
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, Japan.
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Lan YQ, Xi ZF, Dong JJ, Chen YM, Wang YF, Feng N. Added value of computed tomography venography in the identification of abnormities in veins of lower extremities. Curr Med Res Opin 2022; 38:927-936. [PMID: 35321594 DOI: 10.1080/03007995.2022.2057151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the efficacy of direct computed tomography venography (CTV) in early and accurate detection of lower extremity venous (LEV) abnormalities. METHODS Cross-sectional research was conducted in Hebei General Hospital of China. A total of 211 CTV reports of both lower extremities from January 2017 to September 2019, 75 color Doppler ultrasound (DUS) examinations, and eight intravascular angiography records of these patients over the same period were collected from the hospital. Comparisons were made for the reported number and percentage of LEV abnormalities (thrombosis, stenosis including severe stenosis, and varicosities). Chi-square test and t-test were applied to compare the rates and means, respectively. Significance level α was 0.05. Individual interviews were performed to understand the perceptions of medical staff and patients on the application of CTV, and the interview results were analyzed. RESULTS Of the 75 cases with both CTV and DUS reports, 159 abnormalities occurring in the lower extremity deep veins (LEDV) were reported, among which 125 (79%) and 18 (11%) were reported by CTV and DUS on a single basis, respectively, whereas 16 (10%) were reported by CTV and DUS simultaneously. A statistically significant greater number of abnormalities in LEDV were identified by CTV than DUS in both males and females (χ2males = 78.449, χ2females = 27.574, χ2total = 104.164, p < .05). In the 211 CTV reports, among the 383 abnormalities reported in total, the common iliac vein (CIV) had the highest number of reported abnormalities (132, 34.5%), followed by the femoral vein (93, 24.3%). The ratios between LEDV abnormality and patient numbers were 1.055 and 0.688 for left and right sides in males, and 0.892 and 0.461 for left and right sides in females, respectively, with that for the left side statistically significantly higher than the right one (tmale = 2.896, tfemale = 4.347, p < .05). The incidence of thrombosis was 10.9% (95% CI = 6.7 ∼ 15.1%). Reported abnormities in CIV by CTV were in agreement with those by intravascular angiography. The medical staff believed that CTV could guide the performance of surgeries for LEV and the patients perceived CTV acceptable. CONCLUSIONS Application of CTV for early and accurate detection of LEDV abnormalities including thrombosis has been proven to be efficient. Corresponding benefit in early intervention and reduction of severe complications of such abnormalities is of important value. CTV earned good recognition from medical staff and patients. Hence, it could be considered as part of global health assistance cooperation with developing countries to facilitate enhanced medical services.
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Affiliation(s)
- Yan-Qin Lan
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Zhi-Feng Xi
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Jia-Jie Dong
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Ying-Min Chen
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Yu-Fei Wang
- International Cooperation, China Foundation for Poverty Alleviation, Beijing, P.R. China
| | - Ning Feng
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
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Saleem T, Raju S. Comparison of intravascular ultrasound and multidimensional contrast imaging modalities for characterization of chronic occlusive iliofemoral venous disease: A systematic review. J Vasc Surg Venous Lymphat Disord 2021; 9:1545-1556.e2. [PMID: 34580241 PMCID: PMC8479142 DOI: 10.1016/j.jvsv.2021.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/12/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Taimur Saleem
- RANE Center for Venous and Lymphatic Diseases, Jackson, Miss.
| | - Seshadri Raju
- RANE Center for Venous and Lymphatic Diseases, Jackson, Miss
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Abdelmohsen MA, Alkandari BM, Abdel Razek AAK, Tobar AM, Gupta VK, Elsebaie N. Abdominal Computed Tomography Angiography and Venography in Evaluation of Hemorrhagic and Thrombotic lesions in Hospitalized COVID-19 patients. Clin Imaging 2021; 79:12-19. [PMID: 33865171 PMCID: PMC8044556 DOI: 10.1016/j.clinimag.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 02/07/2023]
Abstract
Purpose To report imaging findings at computed tomography angiography (CTA) and venography (CTV) of the abdomen and pelvis in evaluation of hemorrhagic and thrombotic lesions in hospitalized patients with COVID-19. Methods In this retrospective observational study, patients admitted to a single tertiary care center from April 1 to July 20, 2020, who tested positive for SARS-CoV-2 and developed acute abdominal pain or decreasing hemoglobin levels over the course of hospitalization were included. Abdominal CTA/CTV imaging studies performed in these patients were reviewed, and acute hemorrhagic or thromboembolic findings were recorded. Results A total of 40 patients (mean age, 59.7 years; 20 men, 20 women) were evaluated. Twenty-five patients (62.5%) required intensive care unit (ICU) admission and 15 patients (37.5%) were treated in the medical ward. Hemorrhagic complications were detected in 19 patients (47.5%), the most common was intramuscular hematoma diagnosed in 17 patients; It involved the iliopsoas compartment unilaterally in 10 patients, bilaterally in 2 patients and the rectus sheath in 5 cases. Pelvic extraperitoneal hemorrhage was found in 3 patients, and mesenteric hematoma in one patient. Thromboembolic events were diagnosed in 8 patients (20%) including; arterial thrombosis (n = 2), venous thrombosis (n = 2), splenic infarct (n = 1), bowel ischemia (n = 1) and multiple sites of thromboembolism (n = 2). Conclusion Our study highlights that both hemorrhagic and thromboembolic complications can be seen in hospitalized patients with COVID-19. It is important that radiologists maintain a high index of suspicion for early diagnosis of these complications.
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Affiliation(s)
- Mohsen Ahmed Abdelmohsen
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion Street, Alexandria 21131, Egypt; Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | - Buthaina M Alkandari
- Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | | | - Ahmed Mohamed Tobar
- Medical Imaging Department, Jaber Al Ahmad Hospital, Ministry of Health, Khalid Ben Abdulaziz Street, South Surra, Kuwait City, Kuwait
| | | | - Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion Street, Alexandria 21131, Egypt.
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Sato T, Yoshimura N, Horii Y, Yamazaki M, Sato K, Kumagai K, Ishikawa H. Low Tube Voltage Computed Tomography Venography for Patients With Deep Vein Thrombosis of the Lower Extremities - A Comparison With Venous Ultrasonography. Circ J 2021; 85:369-376. [PMID: 33441495 DOI: 10.1253/circj.cj-20-0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low tube voltage computed tomography venography (CTV) can be expected to increase imaging contrast and decrease radiation exposure by using iterative reconstruction (IR). This study evaluated the diagnostic ability of low tube voltage CTV with IR for deep vein thrombosis (DVT), compared to ultrasonography (US).Methods and Results:Two experienced radiologists retrospectively reevaluated the CTV data of 55 of 318 consecutive patients suspected of having DVT or pulmonary embolism between December 2015 and April 2017. The 55 patients had undergone both low tube voltage CTV and US (within 1 day before or after CTV). The lower extremity veins were divided into 10 segments. The DVT forms were categorized into 3 types: complete, concentric, and eccentric. We analyzed the 534 overall segments (16 segments excluded in US) measured using both CTV and US. The sensitivity-specificity was overall 73.3-90.0%, for femoropopliteal, it was 90.0-93.2%, and for the calf, it was 71.1-87.2%. The diagnostic accuracy between the 'eccentric only' and 'others' groups focusing on DVT forms was compared, and significant differences were revealed, especially in the muscular vein. CONCLUSIONS The DVT diagnostic ability above the knee was comparable between low tube voltage CTV with IR and conventional CTV, and the radiation dose was reduced. It was suggested that eccentric DVT measured by CTV tend to be a false-positive, especially in the calf muscular vein.
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Affiliation(s)
- Tatsuhiko Sato
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Norihiko Yoshimura
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Yosuke Horii
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Motohiko Yamazaki
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Ken Sato
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazuki Kumagai
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences
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Fujimoto Y, Ishibashi R, Maki Y, Kitagawa M, Kinosada M, Kurosaki Y, Ikeda H, Chin M. A Simple Surgical Technique for Pediatric Sinus Pericranii: Intraoperative Manual Compression of a Major Shunting Point. Pediatr Neurosurg 2021; 56:286-291. [PMID: 33780955 DOI: 10.1159/000514478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sinus pericranii is a vascular anomaly with extra- and intracranial venous connections. Sinus pericranii is categorized into 2 groups according to its contribution to the normal venous circulation. The accessory type sinus pericranii, which does not contribute to the normal major venous circulation, can be managed. Despite several proposed operative maneuvers, a standardized technique is yet to be established to control intraoperative bleeding. CASE PRESENTATION A 2-week-old neonate underwent examination of a subcutaneous mass in the parieto-occipital region. The subcutaneous mass had a major venous connection to the superior sagittal sinus on ultrasonography. The subcutaneous mass was partially thrombolized on magnetic resonance imaging and was minimally enhanced on computed tomography venography. The subcutaneous mass seemed not to contribute to the normal venous circulation. Surgical removal of the subcutaneous mass was performed due to its increased size at the age of 1 year and 3 months. While subcutaneous mass was detached from the scalp, the major venous connection was manually compressed, and minor venous connections were easily detected. The intraoperative bleeding was controllable. The pathological diagnosis was sinus pericranii. The patient is now followed up in the outpatient clinic. No recurrence was seen 18 months after the surgery. DISCUSSION/CONCLUSION Intraoperative hemostasis is essential while sinus pericranii is detached from the cranium. Hemostatic agents such as bone wax or absorbable gelatin and heat coagulation seem to be useful. However, complicative hemorrhage concerning to the preceded technique has been also reported. As seen in our case, to detect minor shunting points between the sinus pericranii and the intracranial veins, the major venous connection was manually compressed. Intraoperative manual compression of a major venous connection of sinus pericranii can be an option to manage intraoperative bleeding.
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Affiliation(s)
- Yuki Fujimoto
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masashi Kitagawa
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | | | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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Zhao Z, Zhang H, Liu B, Shi H, Liu X, Ye K, Wang R, Qin J, Li W, Jiang M, Lu X, Yin M. Three-dimensional computed tomography venography reconstruction facilitates identification of atypical radiologic features of May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2020; 9:946-953. [PMID: 33248296 DOI: 10.1016/j.jvsv.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE May-Thurner syndrome (MTS) is typically characterized by compression of the left common iliac vein by the overlying right common iliac artery. The present study evaluated the occurrence of atypical imaging features of MTS using three-dimensional computed tomography venography reconstruction (3D-CTV) and analyzed their correlation with clinical features. METHODS We analyzed the data from 268 patients with left lower extremity chronic venous disease (CVD) using 3D-CTV at a single institution from January to June 2019. An area stenosis percentage >50% was defined as significant venous compression. Of the 268 patients, 92 had at least one significant iliac and/or vena cava compression confirmed by 3D-CTV. Of the 92 patients, 89 underwent digital subtraction venography via the left common femoral vein, and the outcomes were compared with their 3D-CTV findings. Different types of venous compression were evaluated using 3D-CTV. The relationship among compression type, sex, age, and CVD symptoms was evaluated. RESULTS A total of 106 venous compression sites were found in 92 patients. Atypical compression included inferior vena cava (IVC) compression and partial IVC compression (8.5% and 55.7%, respectively). Multiple compression sites were present in 13 patients (14.1%). The compression sites correlated significantly with clinical symptoms (P = .017) and were related to sex (P = .001). The number of patients with IVC and partial IVC compression but false-negative venography findings was four (33.3%) and six (50%), respectively. CONCLUSIONS 3D-CTV facilitates the detection of atypical venous compression in patients with MTS with notable chronic symptoms. Patients with multiple compression sites had more severe clinical symptoms and greater false-negative rates with venography. IVC compression was more likely to occur in female patients with MTS.
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Affiliation(s)
- Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Hongze Zhang
- Emergency Critical Care Division, Shanghai Songjiang District Central Hospital, Songjiang Hospital affiliated to Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Bing Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Huihua Shi
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Ruihua Wang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Mier Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China.
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Toh MR, Tang TY, Lim HHMN, Venkatanarasimha N, Damodharan K. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol 2020; 12:18-28. [PMID: 32226586 PMCID: PMC7061234 DOI: 10.4329/wjr.v12.i3.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.
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Affiliation(s)
- Ming Ren Toh
- Duke-NUS Medical School, Singapore 544886, Singapore
| | - Tjun Yip Tang
- Department of Vascular surgery, Singapore General Hospital, Singapore 169608, Singapore
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van Dam LF, van Walderveen MAA, Kroft LJM, Kruyt ND, Wermer MJH, van Osch MJP, Huisman MV, Klok FA. Current imaging modalities for diagnosing cerebral vein thrombosis - A critical review. Thromb Res 2020; 189:132-139. [PMID: 32220779 DOI: 10.1016/j.thromres.2020.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
Abstract
Cerebral vein thrombosis (CVT) is a rare presentation of venous thromboembolism. Prompt and accurate diagnosis is essential as delayed recognition and treatment may lead to permanent disability or even death. Since no validated diagnostic algorithms exist, the diagnosis of CVT mainly relies on neuroimaging. Digital subtraction angiography (DSA) is the historical diagnostic standard for CVT, but is rarely used nowadays and replaced by computed tomography (CT) and magnetic resonance imaging (MRI). High quality studies to evaluate the diagnostic test characteristics of state of the art imaging modalities are however unavailable to date. This review provides an overview of the best available evidence regarding the diagnostic performance of CT and MRI for the diagnosis of CVT. Notably, available studies are observational, mostly small, outdated, and with a high risk of bias. Therefore, direct comparison between studies is difficult due to large diversity in study design, imaging method, reference standard, patient selection and sample size. In general, contrast-enhanced techniques are more accurate for the diagnosis of CVT then non-contrast-enhanced techniques. CT venography and MRI have been both reported to be adequate for establishing a final diagnosis of CVT, but choice of modality as used in clinical practice depends on availability, local preference and experience, as well as patient characteristics. Our review underlines the need for high-quality diagnostic studies comparing CT venography and MRI in specific settings, to improve clinical care and standardize clinical trials.
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Affiliation(s)
- Lisette F van Dam
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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Arai N, Tabuse M, Nakamura A, Miyazaki H. Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report. BMC Neurol 2016; 16:69. [PMID: 27193638 PMCID: PMC4870743 DOI: 10.1186/s12883-016-0597-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 05/12/2016] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of cerebral venous thrombosis (CVT) is low, and in particular, isolated cortical vein thrombosis (ICVT) is very rare. The diagnosis of ICVT is difficult by using conventional computed tomography (CT) and magnetic resonance imaging (MRI). However, with appropriate treatment, ICVT has a good prognosis. Case presentation Herein, we present a rare case of a 40-year-old woman with ICVT and type II protein S (PS) deficiency, who experienced a stroke. She initially presented with generalized convulsions. A CT scan showed intracerebral hemorrhage (ICH) in the left temporoparietal region. However, her condition rapidly deteriorated and she went into a coma approximately 20 h after admission. A second CT scan revealed significant ICH expansion and transfalcine herniation. Decompressive hemicraniectomy with duraplasty was performed, and ICVT was confirmed owing to abnormal vascular tone and black appearance of the cortical vein. She underwent anticoagulation therapy and rehabilitation, and gradually recovered. Conclusion We experienced an extremely rare case of isolated cortical vein thrombosis related with type II PS deficiency. CT-digital subtraction angiography is a useful supportive technique in the diagnosis of ICVT. Decompressive hemicraniectomy is effective for hemorrhage extension cases, and ICVT with hemorrhage might require early anticoagulation therapy.
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Affiliation(s)
- Nobuhiko Arai
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan.
| | - Masanao Tabuse
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
| | - Akiyoshi Nakamura
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
| | - Hiromichi Miyazaki
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
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Takemoto K, Higashi T, Sakamoto S, Inoue T. Successful sinus restoration for transverse-sigmoid sinus dural arteriovenous fistula complicated by multiple venous sinus occlusions: The usefulness of preoperative computed tomography venography. Surg Neurol Int 2015; 6:137. [PMID: 26392914 PMCID: PMC4553663 DOI: 10.4103/2152-7806.163176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/25/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although sinus restoration for transverse-sigmoid sinus (TSS) dural arteriovenous fistula (DAVF) has rarely been reported over the past decade, its advantage and indication still remain unclear. Herein, we discuss the indications and technical aspects of this therapy with a review of the literature. CASE DESCRIPTION A 79-year-old female was referred to our department with generalized convulsion. An angiogram revealed a DAVF at the junction of the right TSS. The right sigmoid and left transverse sinuses were occluded, which resulted in remarkable leptomeningeal venous reflux and cerebral venous congestion. A preoperative computed tomography (CT) venogram precisely revealed the occluded segment of the right sigmoid sinus, which facilitated the sinus restoration with balloon percutaneous transluminal angioplasty and stenting. CONCLUSION Sinus restoration is preferable in patients with severe cerebral venous congestion due to multiple sinus occlusions and/or a restricted collateral venous outlet. CT venography is useful for precise evaluation of the length and configuration of the occluded segment, which thus make it possible to evaluate the feasibility of stenting.
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Affiliation(s)
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital and Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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