RT Journal Article
SR Electronic
T1 Unilateral Nonvisualization of a Transverse Dural Sinus on Phase-Contrast MRV: Frequency and Differentiation from Sinus Thrombosis on Noncontrast MRI
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 115
OP 121
DO 10.3174/ajnr.A6337
VO 41
IS 1
A1 Y.-M. Chang
A1 A.L. Kuhn
A1 N. Porbandarwala
A1 R. Rojas
A1 V. Ivanovic
A1 R.A. Bhadelia
YR 2020
UL http://www.ajnr.org/content/41/1/115.abstract
AB BACKGROUND AND PURPOSE: Unilateral decreased/nonvisualization of a transverse dural sinus on MRV poses a diagnostic dilemma when gadolinium administration is contraindicated. We determined the frequency of unilateral decreased/nonvisualization of the transverse dural sinus and the performance of pregadolinium MR imaging sequences in diagnosing transverse sinus thrombosis in the presence of unilateral decreased/nonvisualization on phase-contrast MRV.MATERIALS AND METHODS: We conducted a retrospective review of consecutive 3D phase-contrast MRV (VENC, 30 cm/s) and routine brain imaging (noncontrast sagittal T1, axial T2, FLAIR, DWI, GRE, and postgadolinium 3D-MPRAGE images) performed during a 3-year period for a total of 208 patients. Nonvisualization of a transverse dural sinus was defined as ≥50% nonvisualization of the transverse sinus caliber versus the contralateral side on MRV. Noncontrast imaging findings were considered abnormal when hyperintense signal was present on T2, FLAIR, T1, and DWI, and there were T2* blooming artifacts on GRE and DWI. Postgadolinium 3D-MPRAGE was used to confirm the diagnosis of transverse sinus thrombosis.RESULTS: Nonvisualization of a transverse dural sinus was observed in 72/208 (34.6%) patients on MRV; 56/72 (77.8%) were without transverse sinus thrombosis, and 16/72 (22.2%) patients had transverse dural sinus thrombosis. Nonvisualization of a transverse dural sinus was seen in 56/192 (29.2%) patients without transverse sinus thrombosis and 16/16 (100%) with transverse sinus thrombosis. Abnormal findings on DWI (transverse sinus hyperintense signal or T2* blooming artifact) are 93.8% sensitive and 100.0% specific for transverse sinus thrombosis. Other noncontrast MR imaging sequences ranged from 56.3%–68.8% sensitive and 91.1%–100.0% specific.CONCLUSIONS: Nonvisualization of a transverse dural sinus is a frequent phenomenon on phase-contrast MRV. DWI can be effectively used to exclude sinus thrombosis when nonvisualization of a transverse dural sinus is a diagnostic conundrum on phase-contrast MRV and contrast-enhanced studies are contraindicated.CEcontrast-enhancedCVTcerebral venous thrombosisDSTdural venous sinus thrombosisMPRAGE+postgadolinium 3D-MPRAGEMRI–noncontrast MRI brain sequencesNVunilateral decreased/nonvisualizationNVTSnonvisualization of a transverse dural sinusPCphase-contrastTStransverse dural sinusTST+transverse sinus thrombosisTST–no transverse sinus thrombosis