Cerebral MR venography: normal anatomy and potential diagnostic pitfalls

Abstract

Background and purpose: MR venography is often used to examine the intracranial venous system, particularly in the evaluation of dural sinus thrombosis. The purpose of this study was to evaluate the use of MR venography in the depiction of the normal intracranial venous anatomy and its variants, to assess its potential pitfalls in the diagnosis of dural venous sinus thrombosis, and to compare the findings with those of conventional catheter angiography.

Methods: Cerebral MR venograms obtained in 100 persons with normal MR imaging studies were reviewed to determine the presence or absence of the dural sinuses and major intracranial veins.

Results: Systematic review of the 100 cases revealed transverse sinus flow gaps in 31% of the cases, with 90% of these occurring in the nondominant transverse sinus and 10% in the codominant transverse sinuses. No flow gaps occurred in the dominant transverse sinuses. The superior sagittal and straight sinuses were seen in every venogram; the occipital sinus was seen in only 10%. The vein of Galen and internal cerebral veins were also seen in every case; the basal veins of Rosenthal were present in 91%.

Conclusions: Transverse sinus flow gaps can be observed in as many as 31% of patients with normal MR imaging findings; these gaps should not be mistaken for dural sinus thrombosis.

fig 1.

A–C, Transverse sinuses were found to be right (A), left (B), and codominant (C) in 59%, 25%, and 16% of the cases examined, respectively.

fig 2.

A and B, Length of flow gap is approximately one third (A, arrow) or two thirds (B, arrow) the size of the ipsilateral sinus

fig 3.

A and B, The superior sagittal sinus (straight arrow), straight sinus (arrowhead), and vein of Galen (curved arrow) are clearly depicted, and were seen in all 100 cases studied, without flow gaps. C and D, The right vein of Labb´e (C, arrow) was seen in 91% of the cases. The right vein of Trolard (D, arrow), depicted as a large tributary to the superior sagittal sinus, was seen in only 37% of the cases.

fig 4.

A and B, Venous phase of a conventional intra-arterial catheter angiogram clearly shows flow within the nondominant transverse sinus (A, arrow), whereas corresponding MR venogram (B) shows a flow gap