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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain
Open Access

Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression

G. Wang, X. Yang, J. Duan, N. Zhang, M.M. Maya, Y. Xie, X. Bi, X. Ji, D. Li, Q. Yang and Z. Fan
American Journal of Neuroradiology October 2019, 40 (10) 1725-1730; DOI: https://doi.org/10.3174/ajnr.A6212
G. Wang
From the Department of Biomedical Sciences (G.W., N.Z., Y.X., D.L., Q.Y., Z.F.), Biomedical Imaging Research Institute
cDepartment of Radiology (G.W.), The First Affiliated Hospital of China Medical University, Shenyang, China
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X. Yang
eRadiology (X.Y., Q.Y.) Xuanwu Hospital, Capital Medical University, Beijing, China
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J. Duan
dDepartments of Emergency (J.D., X.J.)
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N. Zhang
fPaul C. Lauterbur Research Center for Biomedical Imaging (N.Z.), Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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M.M. Maya
bDepartment of Imaging (M.M.M.), Cedars-Sinai Medical Center, Los Angeles, California
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Y. Xie
From the Department of Biomedical Sciences (G.W., N.Z., Y.X., D.L., Q.Y., Z.F.), Biomedical Imaging Research Institute
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X. Bi
gMR R&D (X.B., D.L.), Siemens Healthineers, Los Angeles, California
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X. Ji
dDepartments of Emergency (J.D., X.J.)
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D. Li
From the Department of Biomedical Sciences (G.W., N.Z., Y.X., D.L., Q.Y., Z.F.), Biomedical Imaging Research Institute
gMR R&D (X.B., D.L.), Siemens Healthineers, Los Angeles, California
hDepartments of Medicine (D.L., Z.F.)
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Q. Yang
From the Department of Biomedical Sciences (G.W., N.Z., Y.X., D.L., Q.Y., Z.F.), Biomedical Imaging Research Institute
eRadiology (X.Y., Q.Y.) Xuanwu Hospital, Capital Medical University, Beijing, China
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Z. Fan
From the Department of Biomedical Sciences (G.W., N.Z., Y.X., D.L., Q.Y., Z.F.), Biomedical Imaging Research Institute
hDepartments of Medicine (D.L., Z.F.)
iBioengineering (Z.F.), University of California, Los Angeles, California.
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  • Fig 1.
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    Fig 1.

    SNR of residual blood (RB), CNR between brain parenchyma (BP) and normal lumen (NL), and CNR between RB and NL in the healthy volunteer group. SNR of RB and RB-to-NL CNR were significantly reduced on BTI DANTE+ images compared with those on BTI DANTE- images. Double asterisks denote P < .001.

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    Fig 2.

    BTI (with/without DANTE preparation) images and MRV images of 3 patients with CVT. On BTI DANTE− images, isointense signals appear in the superior sagittal sinus (arrows, A), vein of Galen (arrow, B), and right transvers sinus (arrow, C). However, they are not shown on the BTI DANTE+ images (arrows). MRVs for these 3 patients demonstrate no filling defects on corresponding segments (arrows).

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    Fig 3.

    Thrombus volumes on BTI DANTE+ and BTI DANTE− images. In the 8 patients who were diagnosed with apparent thrombi in the superior sagittal sinus, the measured thrombus volume was significantly lowered (4.814 ± 2.278 mL versus 6.341 ± 2.302 mL, P =.008) when using the DANTE preparation.

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    Fig 4.

    A, SNR of residual blood (RB), CNR between RB and normal lumen (NL), and CNR between RB and thrombus in the patient group. SNR of RB and RB-to-NL CNR was significantly reduced on BTI DANTE+ images compared with BTI DANTE− images. RB-to-thrombus CNR was significantly improved for the isointense thrombus type. B, CNR between thrombus and NL and CNR bet-ween thrombus and brain parenchyma (BP). When one used the DANTE preparation, the CNR between thrombus and NL or BP was not significantly sacrificed except for the CNR between isointense thrombus and NL. THRiso indicates isointense thrombus; THRhyper, hyperintense thrombus; asterisk, P < .05.

Tables

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    Table 1:

    Clinical characteristics of patients with CVT

    PatientSexAge (yr)SymptomDurationConventional Imaging Methods
    1F47Headache2 daysTSE, SWI, CE-MRV, TOF-MRV, CT
    2M19Headache10 daysTSE, TOF-MRV, CT
    3M54Focal neurologic deficit13 daysTSE, SWI, CE-MRV, TOF-MRV, CT
    4M30Headache, focal neurological deficit20 daysTSE, CE-MRV, TOF-MRV, CT
    5M44Seizures25 daysTSE, TOF-MRV
    6F53Headache27 daysTSE, SWI, CE-MRV, TOF-MRV, CT
    7M42Headache1 moTSE, CE-MRV, TOF-MRV
    8F32Headache1 mo + 22 daysTSE, SWI, CE-MRV, TOF-MRV, CT
    9M19Headache2 moTSE, TOF-MRV, CT
    10F28Headache4 moTSE, TOF-MRV, CT
    11F45Headache, papilledema4 moSWI, TOF-MRV, CT
    12F36Headache1 yearTSE, CE-MRV, TOF-MRV, CT
    13F19Headache2 daysTSE, TOF-MRV, CE-MRV
    • View popup
    Table 2:

    Locations of thrombi and residual flow artifacts identified on BTI with and without DANTE preparationa

    Pt. No.Segments
    SSSISSVGSSCSRTSLTSRSSLSSICVBVRVLRCLCRJVLJV
    1=====
    2==
    3+/==+==++
    4===+/===+====
    5
    6========
    7====+/===
    8+/=++/=+/=+/=====++/=+/=
    9=========
    10+/=+/=+/=+/=+/==
    11
    12=======
    13===
    • Note:—SSS indicates superior sagittal sinus; ISS, inferior sagittal sinus; VG, vein of Galen; SS, straight sinus; CS, confluence of sinus; RTS, right transverse sinus; LTS, left transverse sinus; RSS, right sigmoid sinus; LSS, left sigmoid sinus; ICV, internal cerebral vein; BVR, basal vein of Rosenthal; VL, vein of Labbé; RC, right cortical vein; LC, left cortical vein; RJV, right jugular vein; LJV, left jugular vein; =, iso-intense thrombus; +, hyperintense thrombus; +/=, hybrid thrombus.

    • ↵a Shadow indicates that residual flow artifacts are present in the segment on BTI without DANTE preparation but not on BTI with DANTE preparation.

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    Table 3:

    Diagnostic performance of BTI with/without DANTE for the detection of CVT on the per-segment level

    Dante+Dante−
    Sensitivity100%100%
    Specificity96.3%83.8%
    PPV93.5%76.6%
    NPV100%100%
    FP3.7%16.2%
    • Note:—PPV indicates positive predictive value; NPV, negative predictive value; FP, false-positive.

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American Journal of Neuroradiology: 40 (10)
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G. Wang, X. Yang, J. Duan, N. Zhang, M.M. Maya, Y. Xie, X. Bi, X. Ji, D. Li, Q. Yang, Z. Fan
Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression
American Journal of Neuroradiology Oct 2019, 40 (10) 1725-1730; DOI: 10.3174/ajnr.A6212

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Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression
G. Wang, X. Yang, J. Duan, N. Zhang, M.M. Maya, Y. Xie, X. Bi, X. Ji, D. Li, Q. Yang, Z. Fan
American Journal of Neuroradiology Oct 2019, 40 (10) 1725-1730; DOI: 10.3174/ajnr.A6212
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