296.Dural venous sinus thrombosis(硬脑膜静脉窦血栓)

每天朗读一段医学影像学英语文章

Imaging Findings: 

CT angiogram shows an irregular filling defect in the superior sagittal sinus (A and B), compatible with venous sinus thrombosis. Axial FLAIR images show sulcal nonsuppression of CSF with a small left posterior frontal focus of intraparenchymal hemorrhage. Both subarachnoid and intraparenchymal hemorrhagic foci can be seen with venous sinus thrombosis.

CTA示上矢状窦见一不规则充盈缺损，符合静脉窦血栓表现。轴位FLAIR图像显示脑脊液不被抑制，伴左后额叶脑实质内小片出血。静脉窦血栓可见蛛网膜下腔出血和脑实质出血。

Discussion: Dural venous sinus thrombosis is a fairly uncommon disorder, typically seen in the presence of risk factors leading to hypercoagulable state, such as oral contraceptive use, underlying malignancy, protein C or S deficiency, or sinus/mastoid infections.

It is important to note that initial imaging may be a nonvascular study such as NECT or MRI without contrast, often showing findings such as parenchymal or scattered foci of subarachnoid hemorrhage with wide differential possibilities.

Venous infarctions can span multiple arterial vascular territories and present with parenchymal changes such as hemorrhage and cytotoxic and/or vasogenic edema. For this reason, presence of restricted diffusion may not be consistently seen with venous thrombosis. In addition to the parenchymal changes discussed above, NECT may show hyperdense dural venous sinus or cerebral veins. On noncontrast MRI, lack of T2 flow void through venous sinuses may also be seen. For definitive evaluation, venogram studies such as time-of-flight or contrast-enhanced MR venogram, CT venogram, or conventional angiography should be considered.

讨论：硬脑膜静脉窦血栓是极罕见的疾病，通常出现在有高凝状态的危险因素下，例如：口服避孕药、潜在恶性肿瘤、蛋白质C或S缺乏、副鼻窦炎或乳突炎等。重要的是，原始图像可能是非血管性的研究，例如非增强CT或MRI，常显示的结果--例如脑实质出血或散在蛛网膜下腔出血具有广泛的差异可能性。静脉血栓可以阻塞多个动脉血管区域，并导致脑实质改变，例如脑出血或者细胞毒性和（或）血管源性脑水肿。因此，静脉血栓不一定连续可见弥漫受限。除了以上讨论的实质改变之外，非增强CT可能会显示高密度硬脑膜静脉窦或脑静脉。在非增强MRI也可见缺乏T2血管流空效应的静脉窦。至于最后的评估，应该考虑使用静脉造影，例如时间飞跃序列或对比增强序列MR静脉造影、CT静脉造影或者传统血管造影。

Notes:

1. sinus [ˈsaɪnəs] n. 窦

2. thrombosis [θrɑ:mˈboʊsɪs] n. 血栓症

3. subarachnoid [ˌsʌbə'ræknɔɪd] adj. 蛛网膜下的

4. intraparenchymal [ɪntrəpəˈrɛŋkəməl] 实质内的

5. hypercoagulable [haɪpəkə'ʊæɡjʊləbl] 凝固性过高的

6. contraceptive [ˌkɑ:ntrəˈseptɪv] n. 避孕用具; [药]避孕剂

7. mastoid ['mæstɔɪd] adj. 乳头状的

8. cytotoxic [saɪtə'tɒksɪk] adj. 细胞毒素的

From：https://radiologykey.com/vascular-abnormalities-3/

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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