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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Imaging the Cerebral Veins in Pediatric Patients: Beyond Dural Venous Sinus Thrombosis
Asha Sarma1, Dann Martin1, Sumit Pruthi1
1From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.).
Insights
Pediatric intracranial venous anomalies, distinct from adult conditions, include malformations and less common diseases. This review covers embryology, anatomy, imaging techniques, and rare venous conditions in children.
Area of Science:
- Pediatric Neuroradiology
- Cerebrovascular Diseases
Background:
- Intracranial venous anomalies in children present differently than in adults.
- While sinovenous thrombosis is well-documented, less common pediatric cerebral venous diseases require focused attention.
Purpose of the Study:
- To provide a comprehensive overview of less frequently discussed cerebral venous diseases in pediatric patients.
- To discuss relevant embryology, anatomy, and advanced imaging techniques for pediatric venous anomalies.
Main Methods:
- Review of embryological development pertinent to venous malformations.
- Detailed anatomical considerations of pediatric cerebral venous systems.
- Comparison of various imaging modalities and MR venographic sequences.
- Review of congenital and acquired superficial and deep venous diseases in children.
Main Results:
- Embryology and anatomy are crucial for understanding pediatric venous anomalies.
- Medullary, cortical, and bridging veins, along with deep veins and dural sinuses, are key areas of focus.
- Various imaging modalities (US, CT, MRI) and MR venography sequences are evaluated for diagnostic utility.
- A spectrum of congenital and acquired venous diseases, including rare entities, are presented.
Conclusions:
- Understanding the unique embryology and anatomy of pediatric venous systems is essential.
- Advanced imaging techniques are critical for diagnosing diverse and often rare cerebral venous anomalies in children.
- This review highlights less common but significant pediatric venous diseases, aiding in diagnosis and management.
Abstract:
The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been discussed extensively in the literature, and the associated imaging considerations are similar in pediatric and adult patients. The authors shift the focus to less frequently discussed cerebral venous diseases in pediatric patients. First, the practical embryology pertinent to malformations, syndromes, and variants such as vein of Galen aneurysmal malformation, Sturge-Weber syndrome, and developmental venous anomalies are discussed. Second, anatomic considerations that are applicable to neuroimaging in pediatric patients with cerebral venous anomalies are reviewed. In the discussion of anatomy, special attention is given to the medullary venous system that serves the cerebral white matter, superficial cortical veins (tributaries of the dural venous sinuses), and bridging veins, which carry blood from the superficial cortical veins through the potential subdural space into the dural venous sinuses. Third, the selection of imaging modalities (US, CT and CT venography, and MRI) is addressed, and various MR venographic pulse sequences (time-of-flight, phase-contrast, and contrast-enhanced sequences) are compared. Finally, a broad variety of congenital and acquired superficial and deep venous diseases in children are reviewed, with emphasis on less frequently discussed entities involving the medullary (eg, deep medullary venous engorgement and thrombosis, periventricular hemorrhagic venous infarction due to germinal matrix hemorrhage), cortical (eg, cortical venous thrombosis), and bridging (eg, acute and chronic manifestations of injury in abusive head trauma) veins, as well as the deep veins and dural venous sinuses (eg, varix). © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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