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Diffusion-Weighted Magnetic Resonance in Cerebral Venous Thrombosis
Kon Chu, MD;
Dong-Wha Kang, MD, PhD;
Byung-Woo Yoon, MD, PhD;
Jae-Kyu Roh, MD, PhD
Arch Neurol. 2001;58:1569-1576.
Background Cerebral venous thrombosis (CVT) is a cause of stroke with obscure pathophysiologic
properties that differ from arterial stroke. Its main mechanisms of pathophysiology
are the breakdown of the blood-brain barrier and the coexistence of cytotoxic
and vasogenic edema. However, conventional magnetic resonance imaging (MRI)
cannot differentiate between vasogenic and cytotoxic edema.
Objectives To describe the diffusion-weighted imaging (DWI) findings and characterize
the clinical applications of DWI in CVT.
Setting A tertiary referral center, neurology department.
Design and Methods From November 1998 to March 2001, 14 patients (5 men, 9 women; mean
age, 43 ± 10 years) with CVT underwent DWI, conventional MRI, MR venography,
or conventional cerebral angiography. Abnormal findings on DWI and conventional
MRI indicated the necessity of MR venography and conventional angiography
to confirm the diagnosis of CVT. Apparent diffusion coefficient (ADC) values
were measured in all of the abnormal lesions with visual inspection of DWI
and T2-weighted echo planar imaging.
Results Findings on DWI were grouped according to 3 patterns: (1) Heterogeneous
signal intensity (SI) (10 patients) showed mixed bright high SI and low SI
and the corresponding ADC values were inversely correlated to the DWI SI.
The areas of prominent low SI on DWI were reversed with adequate treatment
on follow-up MRI in 1 patient. (2) Multifocal high SI (3 patients) was similar
to that observed in acute arterial stroke. The corresponding ADC values were
decreased and DWI was performed in the acute stages. (3) Intravascular clot
with high SI was found with (1 patient, also in heterogenous SI group) or
without (1 patient) parenchymal lesions. In 1 patient, DWI demonstrated T2-negative
and fluid attenuated inversion recovery–negative lesions without correlative
symptoms.
Conclusions These data suggest that DWI with ADC maps can be used to discriminate
between types of edema for tissue viability and to provide information about
stages and diagnostic clues in CVT.
From the Department of Neurology and Clinical Research Institute, Seoul
National University Hospital, Neuroscience Research Institute of Seoul National
University Medical Research Center, Seoul, Korea.
Corresponding author: Byung-Woo Yoon, MD, PhD, Department of Neurology,
Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul 110-744,
South Korea (e-mail: bwyoon{at}snu.ac.kr).
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