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. 2024 Dec;37(6):738-743.
doi: 10.1177/19714009241260798. Epub 2024 Jun 10.

Contrast-enhanced 3D black-blood magnetic resonance imaging for diagnosis of cerebral venous thrombosis

Padcha Tunlayadechanont  1 , Arin Chobaroon  1 , Thanissara Chansakul  1
Affiliations

Contrast-enhanced 3D black-blood magnetic resonance imaging for diagnosis of cerebral venous thrombosis

Padcha Tunlayadechanont et al. Neuroradiol J. 2024 Dec.

Abstract

Purpose: Cerebral venous thrombosis (CVT) is often under-recognized on routine magnetic resonance imaging (MRI) examinations without concomitant magnetic resonance venography (MRV). Contrast-enhanced black-blood MRI (BBMRI) based on a three-dimensional T1-weighted variable-flip-angle turbo spin echo sequence, one of the sequences used routinely in our practice, has the potential for detection of thrombi in patients with CVT. The aim of this study is to evaluate the diagnostic performance and enhancement patterns of contrast-enhanced three-dimensional BBMRI for the diagnosis of CVT.

Materials and methods: Contrast-enhanced BBMRI and contrast-enhanced MRV sequences of 64 patients, acquired from June 2018 to January 2021, were retrospectively reviewed by neuroradiologists for detection of CVT in each venous sinus segment. Diagnostic performance values were calculated for contrast-enhanced BBMRI based on enhancement patterns.

Results: Of 749 venous segments from 64 patients analyzed, CVT was demonstrated in 41 venous segments from 12 patients on contrast-enhanced MRV (CE MRV). Thick wall enhancement and total enhancement patterns were dominantly demonstrated in thrombosed segments. Compared with contrast-enhanced MRV, contrast-enhanced BBMRI had a patient-based sensitivity and specificity of 100% and 98.1%, respectively, and a segment-based sensitivity and specificity of 87.8% and 96.2%, respectively. The positive predictive value of contrast-enhanced BBMRI in detecting CVT was 92.3% (patient-based) and 57.1% (segment-based), and the negative predictive value was 100% (patient-based) and 99.3% (segment-based).

Conclusion: Contrast-enhanced BBMRI has high diagnostic performance in detection and diagnosis of CVT. This sequence may be useful to recognize CVT when dedicated CE MRV was not performed in patients with nonspecific neurological symptoms.

Keywords: Magnetic resonance venography; black-blood magnetic resonance imaging; cerebral venous thrombosis.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Magnetic resonance images of venous sinus segments obtained in the (a) sagittal plane and (b) coronal plane in the present study show the (1) superior sagittal sinus, (2) inferior sagittal sinus, (3) right transverse sinus, (4) right sigmoid sinus, (5) right internal jugular vein, (6) left transverse sinus, (7) left sigmoid sinus, (8) left internal jugular vein, (9) straight sinus, (10) confluence of sinuses, (11) veins of Galen, and (12) internal cerebral veins.
Figure 2.
Figure 2.
Four types of enhancement patterns on contrast-enhanced black-blood magnetic resonance imaging. (a) No enhancement. (b) Thin wall enhancement. (c) Thick wall enhancement. (d) Total enhancement.
Figure 3.
Figure 3.
Images of an 80-year-old woman who presented with memory loss. (a) Axial contrast-enhanced BBMRI showed thick wall enhancement in the left sigmoid sinus (arrow). (b) Axial contrast-enhanced magnetic resonance venography showed no filling defect in the left sigmoid sinus and indicated that the thick wall enhancement on contrast-enhanced BBMRI was a false-positive finding from the hypoplastic left sigmoid sinus (arrowhead). BBMRI, black-blood magnetic resonance imaging.
See this image and copyright information in PMC

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