Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis.
BACKGROUND
Diffusion-weighted (DWI) and perfusion-weighted (PI) MRI are highly sensitive techniques for early diagnosis of arterial infarction, but little data on venous cerebral ischemia are available. We describe a case in which DWI, PI, and fast T2-weighted sequences were performed in the acute phase of deep cerebral venous thrombosis (CVT).


METHODS
An 11-year-old girl with Crohn's disease developed deep CVT in which extensive edema was shown in the deep gray matter on T2-weighted sequence images. Isotropic echo-planar DWI demonstrated a local augmentation of the apparent diffusion coefficient (1.1 to 1.6x10(-3) mm2/s), consistent with vasogenic edema. In dynamic contrast-enhanced PI, the regional cerebral blood volume was increased and the passage time of the contrast bolus was markedly prolonged. Clinically, the patient recovered totally after intravenous full-dose heparinization. T2 abnormalities, apparent diffusion coefficient values (0.8 to 0.92x10(-3) mm2/s), and brain perfusion alterations resolved without damage to brain tissue.


CONCLUSIONS
Unlike arterial infarction, DWI demonstrated vasogenic edema in a patient with deep CVT, which proved to be reversible in follow-up magnetic resonance imaging. PI showed areas with extensive venous congestion, but perfusion deficits were missing. Therefore, we believe that DWI and PI may play a role in detecting venous congestion in CVT and in prospective differentiation of vasogenic edema and venous infarction.
Keller
E
E
Department of Radiology, University of Bonn, Germany.
Flacke
S
S
Urbach
H
H
Schild
H H
HH
D001929:Brain Edema / Q000175:diagnosis*; D002545:Brain Ischemia / Q000175:diagnosis; D002550:Cerebral Veins; D002648:Child; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*