Diffusion-weighted Image and the Prediction of Brain Venous Thrombosis Development on Magnetic Resonance – Two Case Reports

Czech version

Authors: Andrea Burgetová ¹; Z. Seidl ^1,2; J. Lisý ³; P. Dušek ⁴; M. Mašek ¹; M. Vaněčková ¹
Authors‘ workplace: Radiodiagnostická klinika 1. LF UK a VFN v Praze ¹; Vyšší zdravotnická škola, Praha ²; Klinika zobrazovacích metod 2. LF UK a FN v Motole, Praha ³; Neurologická klinika 1. LF UK a VFN v Praze ⁴
Published in: Cesk Slov Neurol N 2011; 74/107(3): 339-343
Category: Case Report

Overview

We present two cases with diagnoses of cerebral venous thrombosis with extensive pathological changes supporting ischemia on conventional MR imaging (MRI). MR angiography disclosed thrombosis of the vein of Galen and cerebral sinuses. The findings were different on diffusion-weighted imaging (DWI) and on ADC maps. The first case exhibited high signal intensity on DWI and intermediate-to-low signal intensity on ADC (apparent diffusion coefficient) maps in the affected area. This indicated cytotoxic oedema and ischemic lesions. The second case showed intermediate-to-low signal intensity on DWI and high signal intensity on ADC maps. This indicated vasogenic oedema. The severe clinical status of both patients necessitated admittance to the intensive care unit and anticoagulation therapy. In the first case, six months after symptoms onset, signs of organic psychosyndrome, cephalea and vertigo remained. MRI indicated that a residue of the haemorrhage ischemic lesion in the left thalamus persisted, with high signal on T2WI and low signal with mild hypersignal margin on T1WI. In the second case, MR findings and normalization of clinical status after anticoagulation therapy indicated complete remission. We suggest that DWI and ADC contribute to diagnosis and enable a certain degree of prediction of clinical course.

Key words:
cerebral venous thrombosis – magnetic resonance imaging – diffusion weighted imaging – posterior reversible encephalopathy syndrome

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