Clinical importance of imaging anatomical signs in predicting transverse sinus dominance using conventional magnetic resonance imaging

Maryam I. AL-Ani; Qusay A. Fahed; Ali I. Shyaa

doi:10.32007/jfacmedbagdad.6511910

Authors

Maryam I. AL-Ani Department of Surgery, College of Medicne, University of Baghdad, Baghdad, Iraq
Qusay A. Fahed Department of Diagnostic Radiology, Baghdad Teaching Hospital, Medical City, MOH, Baghdad, Iraq
Ali I. Shyaa Department of Diagnostic Radiology, Baghdad Teaching Hospital, Medical City, MOH, Baghdad, Iraq

DOI:

https://doi.org/10.32007/jfacmedbagdad.6511910

Abstract

Background: Differentiating flow gaps associated with hypoplastic transverse sinus from venous thrombosis is a diagnostic challenge in brain magnetic resonance imaging with venography.

Objectives: To assess the clinical benefit of anatomical signs to anticipate the side of the dominant transverse sinus.

Patients and Methods: A total of 100 patients underwent brain magnetic resonance imaging with venography at the radiology department /medical city and were retrospectively reviewed for the direction of superior sagittal sinus flow void, inclination of sulcus for the superior sagittal sinus, angulation of the posterior falx and direction of occipital lobe bending in axial non-contrast T1 weighted image, then compare these findings with a side of the dominant transverse sinus in magnetic resonance venography.

Results: Inclination of sulcus for superior sagittal sinus and superior sagittal sinus flow void direction toward the right side had high positive predictive values (95.5%) and (93.2 %) in proper matching with the right transverse sinus dominance, respectively. Right-sided angulation of the posterior flax and rightward direction of the occipital lobe had a positive predictive value of (90.9 %) in predicting transverse sinus dominance.

Conclusion: The side of dominant transverse sinus can be anticipated by reviewing anatomical signs in T1 weighted image, which may help to differentiate hypoplastic transverse sinus from venous thrombosis that aid in better interpretation of brain MRI- MRV examinations.

Downloads

Download data is not yet available.

References

Sparaco M, Feleppa M, Bigal ME. Cerebral venous thrombosis and headache—a case-series. Headache. 2015; 55: 806-14.

Damak M, Crassard I, Wolff V. Isolated lateral sinus thrombosis: a series of 62 patients. Stroke. 2009;40:476-81.

Leach JL, Fortuna RB, Jones BV. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006;26(Suppl 1):S19-41.

Mizeel AK, Taher NM. Outcomes of cerebral venous thrombosis in Al-Yarmook teaching hospital. Med J Babylon 2021;18:208-12.

Abdullah, M. and Taher, N., 2020. diagnostic value of d-dimer serum level in patient with cerebral venous thrombosis. the Iraqi postgraduate medical journal, 19(3), pp.272-278.

Ayanzen RH, Bird CR, Keller PJ. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol. 2000;21:74-8.

Alper F, Kantarci M, Dane S, Gumustekin K, Onbas O, Durur I. Importance of Anatomical Asymmetries of Transverse Sinuses: An MR Venographic Study. Cerebrovascular Diseases. 2004;18(3):236-239.

Cure´ JK, Van Tassel P, Smith MT. Normal and variant anatomy of the dural venous sinuses. Semin Ultrasound CT MR. 1994;15:499–519.

Kitamura MAP, Costa LF, Silva DOA, Batista LL, Holanda MMA, Valença MM. Cranial venous sinus dominance: what to expect? Analysis of 100 cerebral angiographies. Arq Neuropsiquiatr. 2017 May;75(5):295-300. doi: 10.1590/0004-282X20170042. PMID: 28591389.

Arsava EY, Arsava EM, Oguz KK, Topcuoglu MA. Occipital Petalia as a predictive imaging sign for transverse sinus dominance. Neurological Research. 2019;41(4):306–11.

Chik Y, Gottesman RF, Zeiler SR. Differentiation of transverse sinus thrombosis from congenitally atretic cerebral transverse sinus with CT. Stroke. 2012;43:1968-1970..

Kertesz A, Black SE, Polk M, Howell J. Cerebral asymmetries on Magnetic Resonance Imaging. Cortex. 1986;22(1):117–27.

Maller JJ, Thomson RHS, Rosenfeld JV, Anderson R, Daskalakis ZJ, Fitzgerald PB. Occipital bending in depression. Brain. 2014;137(6):1830–7.

Pettersson DR, McLouth JD, Addicott B. The gibraltar sign: an anatomic landmark for predicting transverse sinus dominance Laterality on Conventional MRI. J Neuroimaging. 2018 Jan; 28(1):99–105.

Leach JL, Strub WM, Gaskill-Shipley MF. Cerebral venous thrombus signal intensity and susceptibility effects on gradient recalled-echo MR imaging. Am J Neuroradiol 2007;28:940-5.

Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791-8.

Kumar A, Mukund A, Sharma GL. Dural venous thrombosis-a neglected finding on routine MRI sequences. Indian J Radiol Imaging. 2006;16:276.

Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW. Skull Base Anatomy. Otolaryngol Clin North Am. 2016 Feb;49(1):9-20.

Cantu C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium; review of 67 cases. Stroke. 1993;24:1880-1884.

Hinman J, Provenzale J. Hypointense thrombus on T2- weighted MR imaging: A potential pitfall in the diagnosis of dural sinus thrombosis. Eur J Radiol. 2002;41:147-52.

Pai V, Khan I, Sitoh Y, Purohit B. Pearls and Pitfalls in the Magnetic Resonance Diagnosis of Dural Sinus Thrombosis: A Comprehensive Guide for the Trainee Radiologist. Journal of Clinical Imaging Science. 2020;10:77.

Surendrababu NR, Subathira, Livingstone RS. Variations in the cerebral venous anatomy and pitfalls in the diagnosis of cerebral venous sinus thrombosis: low field MR experience. Indian J Med Sci. 2006;60:135- 142.

Patel D, Machnowska M, Symons S, Yeung R, Fox AJ, Aviv RI, et al. Diagnostic performance of routine brain MRI sequences for dural venous sinus thrombosis. Am J Neuroradiol. 2016;37:2026–32. doi: 10.3174/ajnr.A4843.

Jalli R, Zarei F, Farahangiz S, Khaleghi F, Petramfar P, BorhaniHaghighi A, et al. The sensitivity, specificity, and accuracy of contrast-enhanced T1-weighted image, T2*-weighted image, and magnetic resonance venography in diagnosis of cerebral venous sinus thrombosis. J Stroke Cerebrovasc Dis. 2016;25:2083–6. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.0

Ayanzen RH, Bird CR, Keller PJ, McCully FJ, Theobald MR, Heiserman JE. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol. 2000 Jan;21(1):74-8. PMID: 10669228.

Saiki K, Tsurumoto T, Okamoto K. Relation between bilateral differences in internal jugular vein caliber and flow patterns of dural venous sinuses. Anat Sci Int. 2013 Jun;88(3):141–150. PubMed PMID: 23572397; PubMed Central PMCID: PMCPMC3654179.