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Neuroimaging findings in pediatric cerebral sinovenous thrombosis
Matthias W Wagner1, Thangamadhan Bosemani, Alexander Oshmyansky
1Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Charlotte R. Bloomberg Children's Center, Sheikh Zayed Tower, The Johns Hopkins University School of Medicine, Room 4174, 1800 Orleans Street, Baltimore, MD, 21287-0842, USA.
Insights
Diagnosing pediatric cerebral sinovenous thrombosis (CSVT) using MRI requires careful analysis of signal changes over time. Diffusion-weighted/tensor imaging (DWI/DTI) offers limited additional diagnostic value for CSVT.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Pediatric cerebral sinovenous thrombosis (CSVT) is a serious neurological condition in children.
- Magnetic Resonance Imaging (MRI) is the primary diagnostic tool for CSVT.
Purpose of the Study:
- To analyze signal changes in thrombi over time in pediatric patients with CSVT.
- To evaluate the diagnostic utility of diffusion-weighted/tensor imaging (DWI/DTI) in CSVT.
Main Methods:
- Retrospective review of clinical histories and MRI studies in 33 children with CSVT.
- Evaluation of thrombus appearance on various MRI sequences including T1/T2-weighted, FLAIR, DWI/DTI, SWI, and MRV.
Main Results:
- Seventy-seven thrombi were identified, with high detection rates on T1/T2-weighted (96%), DWI/DTI (94%), and FLAIR (88%) sequences.
- Restricted diffusion was observed in 40% of thrombi on DWI.
- Older thrombi (>1 day) showed a trend towards T1-hyperintensity (p=0.002), but overall correlation between signal intensity and thrombus age was poor.
Conclusions:
- Individual MRI sequences lack sufficient sensitivity for definitive CSVT diagnosis.
- DWI/DTI does not significantly enhance the diagnostic value for CSVT.
- Accurately determining thrombus age based on MRI signal intensity is challenging.
Purpose:
Pediatric cerebral sinovenous thrombosis (CSVT) is a potentially life-threatening condition which is usually diagnosed by MRI. We analyzed the signal changes of the thrombus over time and the role of diffusion-weighted/tensor imaging (DWI/DTI) in the diagnosis of CSVT.
Methods:
Clinical histories were reviewed for risk factors for CSVT, neurologic manifestation, and interval from onset of symptoms related to CSVT to the neuroimaging diagnosis. MRI studies were retrospectively evaluated for the appearance of thrombi on T1- and T2-weighted, fluid-attenuated inversion recovery (FLAIR), DWI/DTI, susceptibility-weighted imaging (SWI), and magnetic resonance venography (MRV) images.
Results:
Thirty-three children with CSVT were included in this study. Seventy-seven thrombi were found. Seventy-four thrombi could be identified on T1- or T2-weighted images (96 %), 72 thrombi were seen on DWI/DTI (94 %) and 68 on FLAIR (88 %). DWI showed restricted diffusion in 29 thrombi (40 %). Thrombi older than 1 day were more likely to have a T1-hyperintense signal (p = 0.002). No additional correlation between signal intensity and age of the thrombi was found. Intraparenchymal changes secondary to CSVT were seen in 11 children.
Conclusion:
MR sequences individually are not sensitive enough to provide the diagnosis. DWI/DTI does not provide complementary diagnostic value. Approximation of the age of the thrombus is difficult because of poor correlation between signal intensity and age of the thrombi.
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