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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
Cerebral venous thrombus signal intensity and susceptibility effects on gradient recalled-echo MR imaging
J L Leach1, W M Strub, M F Gaskill-Shipley
1University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH 45267-0741, USA. james.leach@uc.edu
Background And Purpose:
Cerebral venous thrombus (CVT) signal intensity is variable on MR imaging, and the appearance of CVT on gradient recalled-echo (GRE) sequences has been incompletely assessed. This study was performed to evaluate the GRE imaging appearance of CVT in different stages of thrombus evolution and its relationship to signal intensity on other MR pulse sequences.
Materials And Methods:
The clinical and MR imaging findings in 18 patients with CVT and GRE imaging were reviewed. Sixty-nine thrombosed venous segments were evaluated, and the signal intensity of thrombus relative to gray matter was determined. The degree of thrombus susceptibility effect (SE) was assessed and related to time of imaging after onset of symptoms (clinical thrombus age) and appearance on other pulse sequences. Segments were classified as SE+ (demonstrating susceptibility effect) or SE- (no susceptibility effect).
Results:
Thirty-six venous segments exhibited visible SE. SE+ segments had a clinical thrombus age that was less than that in SE- segments (8.1 versus 24.6 days, P=.003). Sixty-three percent (23/36) of SE+ segments exhibited hypointensity on T2-weighted images (T2WI) versus 12% (4/33) of SE- segments (P<.001). Twenty-nine of 32 (90.6%) segments with clinical thrombus age of 0-7 days were SE+, versus 7 of 30 (23.3%) segments with a thrombus age of 8 days or greater.
Conclusion:
SEs from CVT can be detected with GRE imaging and are most prevalent in patients with hypointense thrombus on T2WI within 7 days after the symptom onset. This correlates with the paramagnetic effects of deoxyhemoglobin in acute stage thrombus. GRE imaging may be useful in detecting thrombus in this stage when difficult to detect on other pulse sequences.
Insights
Gradient recalled-echo (GRE) imaging detects cerebral venous thrombus (CVT) susceptibility effects (SE), especially in acute stages within 7 days. This MRI technique aids in identifying early-stage CVT, which may be missed on other sequences.
Area of Science:
- Radiology
- Neuroimaging
- Vascular Imaging
Background:
- Cerebral venous thrombus (CVT) presents variable signal intensity on MRI.
- Gradient recalled-echo (GRE) sequences for CVT assessment are not fully understood.
Purpose of the Study:
- To evaluate the GRE imaging appearance of CVT across different thrombus evolution stages.
- To correlate GRE findings with signal intensity on other MRI pulse sequences.
Main Methods:
- Reviewed clinical and MR imaging findings in 18 patients with CVT.
- Assessed 69 thrombosed venous segments for susceptibility effects (SE) relative to thrombus age and other pulse sequences.
Main Results:
- Visible SE detected in 36 venous segments, more prevalent in acute thrombi (mean age 8.1 days vs. 24.6 days).
- SE+ segments showed hypointensity on T2-weighted images (T2WI) more often (63% vs. 12%).
- 90.6% of thrombi within 7 days were SE+, compared to 23.3% of older thrombi.
Conclusions:
- GRE imaging detects CVT susceptibility effects (SE), particularly in acute thrombi within 7 days.
- Hypointensity on T2WI correlates with SE+ in acute CVT.
- GRE may enhance detection of early-stage CVT, especially when subtle on other sequences.
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