脑静脉血栓形成影像学诊断与误诊原因分析(附27例报告)

摘要

Objective To evaluate the diagnostic value of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Digital Subtraction Angiography (DSA) in cerebral venous thrombosis(CVT).Methods The clinical data of 27 CVT patients diagnosed by CT, MR, DSA and pathology diagnosis from 2000 to 2010 were analyzed, and all patients underwent head MRI.Among them, 19 patients underwent MRV examination, 21 patients underwent CT, and 15 patients underwent DSA.Results 19 patients were diagnosed by the first imaging examination; 8 patients were misdiagnosed,in whom 7 patients were confirmed by secondary MRV or DSA during the treatment, and 1 case was confirmed by autopsy after death.In this group, 5 patients were isolated deep CVT, 14 patients were isolated venous sinus thrombosis ( VST),and another 8 were DCVT concomitant with VST.The indirect imaging findings were cerebral tissue edema and venous infarction, while the direct imaging sign was cerebral venous thrombosis.Conclusion CT, MR and DSA have certain diagnostic value of CVT, but should be combined with each tool and careful differentiation to improve the diagnostic accuracy.%目的 探讨计算机体层摄影(CT)、磁共振成像(MR)及数字减影血管造影术(DSA)对脑静脉血栓形成的诊断价值.方法 对我院2000～2010年经CT、MR、DSA和病理学诊断证实的27例脑静脉血栓形成临床资料进行回顾性分析.27例均行头部MRI检查,19例行MRV检查,21例行CT检查,15例行DSA检查.结果 本组19例首次影像学检查确诊,8例误诊.误诊病例中7例行MRV或DSA检查确诊,1例死亡后尸检确诊.本组单纯脑深静脉血栓5例,单纯静脉窦血栓14例,脑深静脉血栓并静脉窦血栓8例.影像学直接征象为脑静脉内血栓,间接征象主要为水肿及静脉性梗死.结论 CT、MR及DSA检查对脑静脉血栓形成有一定诊断价值,需各检查结合,仔细分析鉴别,提高诊断率.