High-Resolution Magnetic Resonance Black Blood Thrombus Imaging and Serum D-Dimer in the Confirmation of Acute Cortical Vein Thrombosis

Cerebral cortical vein thrombosis (CCVT) is often misdiagnosed because of its non-specific diagnostic symptoms. Here, we analyzed a cohort of patients with CCVT in hopes of improving understandings and treatments of the disease. A total of 23 patients with CCVT (confirmed with high-resolution imaging), who had been diagnosed between 2017 and 2019, were enrolled in this cohort study. Baseline demographics, clinical manifestations, laboratory data, radiological findings, treatment, and outcomes were collected and analyzed. Fourteen females and nine males were enrolled (mean age: 32.7 ± 11.9 years), presenting in the acute (within 7 days, n = 9), subacute (8–30 days, n = 7), and chronic (over 1 month, n = 7) stages. Headaches (65.2%) and seizures (39.1%) were the most common symptoms. Abnormally elevated plasma D-dimers were observed in the majority of acute stage patients (87.5%). The diagnostic accuracy of contrast-enhanced magnetic resonance venography (CE-MRV) and high-resolution magnetic resonance black-blood thrombus imaging (HR-MRBTI) in detecting CCVT were 57.1 and 100.0%, respectively. All patients had good functional outcomes after 6-month of standard anticoagulation (mRS 0–1) treatment. However, four CCVT patients that had cases involving multiple veins showed symptom relief after batroxobin therapy (p = 0.030). HR-MRBTI may be a fast and accurate tool for non-invasive CCVT diagnosis. HR-MRBTI combined with D-dimer can also precisely identify the pathological stage of CCVT. Batroxobin may safely accelerate cortical venous recanalization in combination with anticoagulation. Follow-up studies with larger sample sizes are suggested to evaluate the safety and efficacy of batroxobin for treating CCVT.

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Accuracy of Magnetic Resonance Direct Thrombus Imaging (MRDTI) As a Novel Tool in the Diagnosis of Acute Ipsilateral Recurrent Deep Vein Thrombosis

Blood ◽

10.1182/blood.v120.21.395.395 ◽

2012 ◽

Vol 120 (21) ◽

pp. 395-395

Author(s):

Melanie Tan ◽

Gerben C Mol ◽

Marcel A Van de Ree ◽

Cornelis J Van Rooden ◽

Robin E Westerbeek ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Ultrasound Examination ◽

Kappa Statistics ◽

Acute Thrombosis ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

Recurrent Deep Vein Thrombosis ◽

Deep Vein ◽

D Dimer

Abstract Abstract 395 Background Accurate diagnostic assessment of suspected acute ipsilateral recurrent deep vein thrombosis (DVT) is of high clinical importance, however discriminating residual thrombosis from acute recurrent DVT may be challenging. It is known that in 32% of the patients with a suspected acute ipsilateral recurrent DVT the ultrasound examination are non-conclusive. Despite this, patients were treated with indefinite anticoagulant therapy, indicating overtreatment in this group of patients (Tan M et al. J Thromb Haemost 2010). A non-invasive MR technique (Magnetic Resonance Direct Thrombus Imaging (MRDTI), without need for intravenous contrast agent, showed high sensitivity and specificity for diagnosing a first acute DVT (Fraser et al Ann Intern Med 2002). Furthermore the high signal associated with acute thrombosis was not detected 6 months after the initial acute thrombosis, making MRDTI potential relevant for distinguishing a recurrent DVT from a residual thrombosis (Westerbeek RE et al J Thromb Haemost 2008). This study evaluated the accuracy of MRDTI in patients with an acute ipsilateral recurrent DVT and patients with residual thrombosis. Patients/Methods In total 84 patients were enrolled. Of these, 42 consecutive patients had an acute ipsilateral recurrent DVT according to the current ultrasound examination standards in combination with a positive D-dimer test (≥ 500 μg/L); all patients were treated with anticoagulants. Furthermore, 42 patients were without acute signs and symptoms, however had a residual thrombosis on ultrasound examination in combination with a negative D-dimer test (< 500 μg/L). All patients received a MR examination within 48 hours of presentation. MR images were assessed in a blinded fashion by two radiologists. Sensitivity, specificity and interobserver variability were calculated. Results The images of two patients with ipsilateral recurrent DVT were not interpretable, one patient had a knee prosthesis that gave artifacts and in the other patient not the venous system of interest was imaged. The images of 40 patients with an ipsilateral recurrent DVT and of 42 patients with residual thrombosis were fully interpretable. Sensitivity was 86% (95% CI, 71 –94%) and specificity was 100% (95% CI, 89–100%) for MRDTI by the first observer; sensitivity was 88% (95% CI, 74–96%) and specificity was 100% (89–100%) by the second observer. The interobserver agreement between both observers was excellent, with a kappa statistics of 0.97 (95% CI, 0.92 – 1.0). Conclusion Our study shows reasonable sensitivity and very good specificity figures with an excellent observer agreement for imaging an ipsilateral recurrent DVT and residual thrombosis with MRDTI. The sensitivity is somewhat lower than expected; a reason could be that patients with inconclusive ultrasounds were considered as acute recurrent thrombosis by the attending physician, while in fact they had a residual thrombosis. We conclude that MRDTI has good potential in distinguishing a residual thrombosis from an acute recurrent DVT and could therefore be of high value for the diagnosis of patients with suspected acute ipsilateral recurrent DVT. This should however be further evaluated in a management outcome study in which treatment decisions are based on the results of MR. Acknowledgment This study was supported by the Netherlands Heart Foundation (grant no. 2007B146) Disclosures: No relevant conflicts of interest to declare.

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Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-018-0459-6 ◽

2018 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

Hanwei Chen ◽

Xueping He ◽

Guoxi Xie ◽

Jianke Liang ◽

Yufeng Ye ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Black Blood ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Diagnosis of cerebral cortical vein thrombosis with T2* weighted magnetic resonance imaging

BMJ Case Reports ◽

10.1136/bcr.03.2009.1651 ◽

2009 ◽

Vol 2009 (sep06 1) ◽

pp. bcr0320091651-bcr0320091651

Author(s):

Y. Katayama ◽

I. Kitajima ◽

H. Niimi ◽

H. Kitahara ◽

H. Kawai

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis ◽

Weighted Magnetic Resonance Imaging

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Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-016-0320-8 ◽

2017 ◽

Vol 19 (1) ◽

Cited By ~ 12

Author(s):

Guoxi Xie ◽

Hanwei Chen ◽

Xueping He ◽

Jianke Liang ◽

Wei Deng ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Black Blood ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Comparison Between the Diagnostic Performance of 1.5 T and 3.0 T field Strengths for Detecting Deep Vein Thrombosis Using Magnetic Resonance Black-Blood Thrombus Imaging

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620921235 ◽

2020 ◽

Vol 26 ◽

pp. 107602962092123

Author(s):

Yufeng Ye ◽

Xueping He ◽

Chen Huang ◽

Caiyun Shi ◽

Wei Deng ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Diagnostic Performance ◽

Diagnostic Technique ◽

Black Blood ◽

Vein Thrombosis ◽

Thrombus Imaging ◽

3.0 T ◽

Deep Vein ◽

Field Strengths

Background: Magnetic resonance (MR) black-blood thrombus imaging (BTI) is an accurate diagnostic technique for detecting deep vein thrombosis (DVT) but to date there have been no studies comparing the diagnostic performance and consistency of this technique at different field strengths. In this study, we evaluated and compared the diagnostic performance of BTI for detecting DVT at 1.5 T and 3.0 T field strengths. Methods: A total of 40 patients with DVT were enrolled in this study from November 2015 up to October 2018. All patients underwent BTI, a contrast-free T1-weighted MR imaging technique for detecting DVT, and contrast-enhanced MR venography (CE-MRV) at 1.5 T or 3.0 T field strengths. The MR data analyses used 1160 segments from the venous lumen of the 40 patients. The signal-to-noise ratio and contrast-to-noise ratio between thrombus and muscle/lumen were calculated to compare BTI at 1.5 T or 3.0 T to determine the image performance for thrombus detection at 1.5 T or 3.0 T. Two physicians blinded to the study evaluated all BTI images and calculated the overall sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV), accuracy, and diagnostic consistency at 1.5 T and 3.0 T. These images and values were compared to control CE-MRV images that had been obtained by 2 senior physicians and used as reference standards. In addition, the reliability and consistency of diagnoses between observers were also evaluated. Results: Two study-blind physicians reviewed all BTI images to diagnose thrombus and to determine SE, SP, PPV, NPV, and accuracy. There were no statistical differences in SE, SP, PPV, NPV, or accuracy between the 1.5 T and 3.0 T groups. Conclusions: Black-blood thrombus imaging has high SE, SP, and accuracy for DVT diagnosis both at 1.5 T and 3.0 T field strengths. This noninvasive diagnostic technique, which does not require the use of contrast agents, can be widely used in the clinical screening of DVT and follow-up after treatment.

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Teaching NeuroImages: Magnetic resonance susceptibility effect for acute isolated cortical vein thrombosis

Neurology ◽

10.1212/wnl.0000000000000988 ◽

2014 ◽

Vol 83 (20) ◽

pp. e178-e179 ◽

Cited By ~ 1

Author(s):

S. Pikija ◽

P. Unterkreuter ◽

M. Knoflach

Keyword(s):

Magnetic Resonance ◽

Cortical Vein ◽

Vein Thrombosis ◽

Susceptibility Effect ◽

Cortical Vein Thrombosis

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Multimodal diagnosis of cortical vein thrombosis

Aktuelle Neurologie ◽

10.1055/s-2007-987497 ◽

2007 ◽

Vol 34 (S 2) ◽

Author(s):

J Linn ◽

T Pfefferkorn ◽

S Michl ◽

M Wiesmann ◽

S Hartz ◽

...

Keyword(s):

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis

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Cerebellar venous thrombosis mimicking a cerebellar tumor due to polycythemia vera: a case report

BMC Neurology ◽

10.1186/s12883-021-02261-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongfeng Wen ◽

Di Jin ◽

Yu Chen ◽

Bin Cui ◽

Tianyi Xiao

Keyword(s):

Venous Thrombosis ◽

Polycythemia Vera ◽

Delayed Diagnosis ◽

Janus Kinase ◽

Cerebellar Hemisphere ◽

Cerebellar Tumor ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis ◽

V617f Mutation

Abstract Background Cerebral venous thrombosis (CVT) occurs rarely in the general population and is frequently associated with confused clinical findings and delayed diagnosis. Isolated cerebellar cortical vein thrombosis is a very rare phenomenon. Case presentation This report describes a case with CVT, which is manifested as space-occupying lesions of the cerebellar hemisphere and mimics a cerebellar tumor at the beginning. The diagnosis of CVT was finalized given the laboratory and brain biopsy findings. The etiology may be related to polycythemia vera with Janus Kinase 2 V617F mutation. Conclusion Isolated cerebellar vein thrombosis should be considered when swelling and enhancing cerebellar lesions are detected. Polycythemia vera, especially with a positive JAK2 V617F mutation, may be a rare risk factor for CVT.

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