磁共振成像和CT平扫对脑静脉窦密度增高的诊断价值  

The diagnostic value of increased density of cerebral venous sinus in unenhanced CT and MRI

作　　者：吕永革 刘祥林 钟金兰 吴冬 罗帝林 郭岳霖 赵志清 郑治强 Lyu Yongge;Liu Xianglin;Zhong Jinlan;Wu Dong;Luo Dilin;Guo Yuelin;Zhao Zhiqing;Zheng Zhiqiang(Department of Radiology,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Guangdong 518104,China)

机构地区：[1]深圳市中西医结合医院放射科,518104

出　　处：《实用医学影像杂志》2022年第5期433-438,共6页Journal of Practical Medical Imaging

基　　金：广东省深圳市宝安区科技创新局基础研究项目(2018JD208)。

摘　　要：目的 探讨脑静脉窦(CVS)密度增高的原因以及磁共振成像(MRI)和CT平扫的诊断价值。方法通过MR平扫、3D增强及CE-MRV对120例CT平扫时CVS密度增高的患者进行对比研究,分析其CT值、形态、边缘是否有显著性差异,CT及MRI是否有关联性。结果 通过MR多序列扫描证实,本组CT平扫CVS密度增高包含CVS优势(n=79)、脑静脉窦血栓(CVST)(n=26)、颅骨伪影(n=5)、小脑幕影(n=7)、运动伪影(n=3);CVST的CT值(67±4)Hu明显高于非血栓(57±4)Hu(P<0.01),且多见于右侧横窦、乙状窦、颈内静脉上端;诊断CVST的最佳CT临界值是62.5 Hu(约登指数为0.909);CVST多表现为形态不规则、边缘毛糙,而非血栓多表现为形态规则、边缘光滑(P<0.01);非血栓患者的横窦密度增高右侧明显多于左侧(P<0.01)。MRV显示CT平扫上CVS密度增高与CVS优势相关(r=0.82,P<0.01),当一侧CVS密度增高则为该侧CVS优势。结论CT平扫上CVS密度增高的原因多样,CT平扫有较高的鉴别诊断价值,MRI多序列检查有很好的补充意义。Objective To explore the factors of increased density of cerebral venous sinus(CVS) and diagnostic value of unenhanced CT and MRI. Methods One hundred and twenty cases of increased density of CVS underwent unenhanced CT were compared with the findings from Plain MR, 3D enhanced MR and contrast-enhanced magnetic resonance venography(CE-MRV) images, analyzed whether there was statistical significance in CT value, shape and edge, and whether there was correlation between CT and MRI images. Results Cerebral venous sinus dominance(n=79), cerebral venous sinus thrombosis(CVST)(n=26), cranial artifact(n=5), cerebellar tentorial shadow(n=7), motion artifact(n=3) in this group, were confirmed by multi-sequence of MRI. The CT value of CVST group(67 ±4)Hu was significantly higher than that of nonthrombus group(57±4)Hu(P<0.01), and was more common in the right transverse sinus, sigmoid sinus, and the upper end of internal jugular vein.The best threshold value for diagnosing CVST was62.5 Hu(Youden index =0.909). Most of the CVST showed irregular morphology, rough edge, but nonthrombus were regular and smooth(P<0.01);The rightside was more than the left in increased density of CVS of nonthrombus group.CE-MRV showed that increased density of CVS in unenhanced CT was relevant with cerebral venous sinus dominance, it was the cerebral venous sinus dominance when it showed increased density of CVS in unehanced CT. Conclusion There are various causes of increased density of CVS in unehanced CT, it has a high value in differential diagnosis of unehanced CT, the multi-sequence of MRI has a good supplementary significance.

关 键 词：脑静脉窦 血栓 伪影 体层摄影术 X线计算机 平扫 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学] R816.1[医药卫生—临床医学]