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Research ArticlePediatric Neuroimaging

2D Time-of-Flight MR Venography in Neonates: Anatomy and Pitfalls

E. Widjaja, M. Shroff, S. Blaser, S. Laughlin and C. Raybaud
American Journal of Neuroradiology October 2006, 27 (9) 1913-1918;
E. Widjaja
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M. Shroff
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S. Blaser
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S. Laughlin
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C. Raybaud
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    Fig 1.

    Coronal (A) and sagittal (B) views from maximum intensity projection (MIP) of 2D TOF MRV demonstrate signal intensity void in the posterior aspect of superior sagittal sinus and medial aspect of transverse sinuses. On the coronal (C) and sagittal (D) reformatted images of the CTV, there is normal flow seen in the superior sagittal sinus and transverse sinuses, which confirms that the signal intensity void seen in the superior sagittal and transverse sinuses is artifactual.

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    Fig 2.

    A, Axial T2 shows loss of the normal flow void in the right transverse sinus (arrows). B, Coronal view of MIP from 2D TOF MRV shows loss of signal intensity in the right and left transverse sinuses. C, Sagittal view of MIP from 2D TOF MRV shows loss of signal intensity in the posterior aspect of superior sagittal sinus (arrow), which is clearly demonstrated despite image degradation by motion. The appearance is suspicious of artifactual flow gap in the transverse sinuses and superior sagittal sinus caused by in-plane saturation, possibly exacerbated by skull molding. Coronal (D) and sagittal (E) reformatted images of CTV show that the transverse and superior sagittal sinuses are patent. This confirms that the flow gaps seen in the venous sinuses on TOF MRV are artifactual. There is, however, persistent narrowing of the superior sagittal sinus in the region where the lambdoid sutures converge (arrowhead), which suggests that skull molding may play a role in narrowing the caliber of the superior sagittal sinus, thereby increasing the likelihood of demonstrating flow gaps in the superior sagittal sinus on 2D TOF MRV in neonates.

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    Fig 3.

    A, Flow gap is seen in the posterior aspect of superior sagittal sinus on the coronal 2D TOF MRV. This flow gap is artifactual as a result of in-plane saturation of the imaging plane. This effect is negated by changing the plane of imaging. B, On the axial 2D TOF MRV, there is flow in the superior sagittal sinus. There is short segment stenosis of the superior sagittal sinus on axial 2D TOF MRV, in the region of the convergence of lambdoid suture, possibly as a result of skull molding and pressure effect in the supine position.

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    Fig 4.

    A and B, MIP images of coronal 2D TOF MRV acquired with TE of 5.5 ms demonstrate flow gap in the superior sagittal sinus and left transverse sinus. The flow gap is artifactual as a result of in-plane saturation. C and D, MIP images of coronal 2D TOF MRV acquired with TE of 4.9 ms. Flow gap due to in-plane saturation is minimized by using shorter TE (4.9 ms) and thereby improves visualization of superior sagittal and transverse sinus. The left transverse sinus is smaller compared with the right transverse sinus but patent, possibly due to congenitally smaller caliber left transverse sinus.

Tables

  • Figures
  • Flow void, stenosis, or absence of venous sinuses detected in 9 neonates who have had coronal 2D time-of-flight MR venography (TOF MRV) and CT venography (CTV)

    Coronal 2D TOF MRV ON MIP ImagesCoronal 2D TOF MRV on Source ImagesCTV
    Superior sagittal sinusNarrowing222
    Flow gap630
    Right transverse sinusFlow gap320
    Absent111
    Left transverse sinusFlow gap640
    Right sigmoid sinusFlow gap320
    Left sigmoid sinusFlow gap210
    Right internal jugular veinFlow gap000
    Left internal jugular veinFlow gap000
    • Note:—MIP indicates maximum intensity projections.

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American Journal of Neuroradiology: 27 (9)
American Journal of Neuroradiology
Vol. 27, Issue 9
October 2006
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Cite this article
E. Widjaja, M. Shroff, S. Blaser, S. Laughlin, C. Raybaud
2D Time-of-Flight MR Venography in Neonates: Anatomy and Pitfalls
American Journal of Neuroradiology Oct 2006, 27 (9) 1913-1918;

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2D Time-of-Flight MR Venography in Neonates: Anatomy and Pitfalls
E. Widjaja, M. Shroff, S. Blaser, S. Laughlin, C. Raybaud
American Journal of Neuroradiology Oct 2006, 27 (9) 1913-1918;
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