Diffusion-weighted Imaging Patterns of Brain Damage Associated with Cerebral Venous Thrombosis
Denis Ducreuxa,
Catherine Oppenheim
,a,
Xavier Vandammea,
Didier Dormonta,
Yves Samsona,
Gérald Rancurela,
Guy Cosnarda and
Claude Marsaulta
a From the Department of Neuroradiology (D.Du., C.O., D.Do., C.M.) and the Cerebrovascular Emergency Department (X.V., Y.S., G.R.), Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, Paris, France, and the Department of Radiology (G.C.), Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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FIG 1. Patient 9, a 34-year-old woman with headaches, cognitive function loss, and sudden-onset right hemiparesis.
A, MR angiogram (axial 2D time-of-flight method, maximum intensity pixel reconstruction, lateral view), obtained 1 day after the onset of neurologic symptoms, shows an occlusion of the deep and superficial venous systems (vein of Galen, straight sinus, internal cerebral veins, anterior part of the superior sagittal sinus).
B, Initial MR image obtained 1 day after the onset of neurologic symptoms. Axial spin-echo T1-weighted image shows bilateral areas of hypointensity at the level of the capsulae. Initial fast-FLAIR (10002/148/2200 [TR/TE/TI]) and diffusion-weighted (4000/120 [TR/TE], b = 1000 s/mm2) images show widespread bilateral areas of hyperintensity in putamen, caudate nuclei, and the capsulae. ADC maps show markedly decreased ADC values (0.33–0.42 10-3 mm2/s) (ie, z scores <-3 when compared with normal-appearing brain).
C, Follow-up MR image obtained 3 months after onset shows normal-appearing brain at the level of the gray nuclei, indicating that most lesions with initially decreased ADC values were reversible. Only focal slight areas of hyperintensity were visible in the centrum semiovale (not shown). Symptoms regressed completely within a few weeks.
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FIG 2. Patient 2, a 41-year-old woman with vomiting, headaches, right hemianopsia, and right sensorimotor deficit of sudden onset.
A, MR angiogram (coronal 2D time-of-flight method, maximum intensity pixel reconstruction, lateral view), obtained 4 days after the onset of neurologic symptoms, shows an occlusion of the deep venous system (internal cerebral veins, straight sinus, vein of Galen). The right transverse sinus was also occluded (not shown).
B, Initial MR imaging and CT were performed 4 days after the onset of neurologic symptoms. CT scan shows a left capsulothalamic hematoma surrounded by edema. Axial FLAIR (10002/148/2200 [TR/TE/TI]) and diffusion-weighted (4000/120 [TR/TE], b = 1000 s/mm2) images show central thalamic hypoisointensity surrounded by areas of hyperintensity. ADC values (0.59 10-3 mm2/s) measured in the hemorrhagic thalamic lesion are at the lower limit of the normal range (z score of -1.91) and increased at the periphery (1.3 10-3 mm2/s, z score = 2.8).
C, Three months later, right hemiparesis persists along with areas of hyperintensity on T1- and T2-weighted images, suggesting the presence of hemorrhagic sequelae.
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FIG 3. Patient 5, a 20-year-old woman with seizures and left motor deficit of sudden onset.
A, CT angiogram, obtained 1 day after onset, shows an occluded superior sagittal sinus. The deep venous system was intact (not shown).
B, Initial MR imaging and CT were performed 1 day after onset. CT scan shows a large area of hypodensity with focal areas of hyperdensity corresponding to a recent hematoma. Axial FLAIR (10002/148/2200 [TR/TE/TI]) and diffusion-weighted (4000/120 [TR/TE], b = 1000 s/mm2) images show a heterogeneous area with predominant areas of hyperintensity and hypointensity at the site of the hematoma seen on the CT scan. ADC map shows mixed areas of increased ADC values (1.66 10-3 mm2/s) (ie, z score >3), at the lower limit of normal values (0.59 10-3 mm2/s) (ie, z score = -1.9), or slightly decreased ADC values (0.58 10-3 mm2/s) (ie, z score <-2).
C, Follow-up MR image obtained 6 months after onset shows left frontal sequelae in areas with initially decreased or normal ADC values (2D time-of-flight source image used to illustrate MR sequelae). The patient had no clinical deficit.
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