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Using MRI and CT to Diagnose Pediatric Cerebral VT Brain Lesions

May 15, 2009
Written by: , Filed in: Pediatric Radiology
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A recent study designed to evaluate the frequency and topographic distribution of brain lesions associated with cerebral sinus venous thrombosis (VT) in children has concluded that cerebral sinus venous thrombosis occurs most commonly in neonates, who are more likely to develop parenchymal lesions, and more commonly hemorrhagic lesions, which are usually within the territory of the affected sinus.

The Study
71 patients diagnosed with VT over a 7-year period were evaluated. They were divided into 3 groups by age:

  • neonates, defined as age 0 to 28 days
  • infants, 29 days to 12 months
  • older children, 1 to 18 years.

Patients with concurrent abnormalities were excluded.

Methodology
Available MR and CT images were evaluated for characteristics of lesions associated with venous thrombosis. MR studies were performed as axial T1, T2 fast spin-echo (FSE), coronal T2 FSE, and sagittal T1.

Coronal 2D time-of-flight MR venogram (MRV) with multiple MIP reconstructed images was performed.

CT studies were performed on an 8-row multidetector CT. Noncontrast images and CT venography with 1.25-mm source images and multiplanar reconstructions were generated. Most patients had MR/MRV or CT/CTV; only 6 had both.

Results of Study:
There were 34 neonates, 10 infants, and 27 older children. The most common locations of VT for neonates and infants were the transverse sinuses, superior sagittal sinus (SSS), and straight sinus.

In older children, they were the SSS, transverse sinus, and sigmoid sinus.

In 10 neonates, there was involvement of the torcular herophili, which was not involved in any of the infants or older children.

In total, 37 of 71 children (52%) with VT had brain parenchymal lesions, which occurred in 62% of neonates, 40% of infants, and 44% of older children.

In all groups, the most common location was the frontal lobe, which in the case of infants was equal to lesions in the cerebellum.

The second location in neonates was the parietal lobe, and in older children, the thalamus.

Lesions correlated with the territory of the thrombosis in 16 of 21 cases, but in 5, all of which were in neonates, they did not, and sometimes even appeared contralateral to the thrombosis.

Hemorrhagic lesions were seen in 16 of 21 neonatal lesions, 3 of 4 infant lesions, and 4 of 12 lesions in older children.

Conclusions
Cerebral sinus venous thrombosis occurs most commonly in neonates, who are more likely to develop parenchymal lesions, and more commonly hemorrhagic lesions, which are usually within the territory of the affected sinus.

Reviewer’s Comments
The article points out that 5 neonates had lesions not associated with the location of the sinus thrombosis. All of these patients underwent CT, and the authors posit that they may have had small cortical vein thromboses that may have been detected with MR. They also posit that the higher incidence of lesions in neonates is due to lack of development of protective mechanisms and collateral pathways that develop later.

Author: Yaron Lebovitz, MD

Reference:
Teksam M, Moharir M, et al. Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis. AJNR; 2008;29 (November-December): 1961-1965

Pediatric Diagnostic Imaging

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Pediatric Diagnostic Imaging program features the advances and diversity of pediatric imaging by reviewing state-of-the-art clinical material and advanced cutting-edge research presentations. This program presents a group of international experts who discuss state-of-the art diagnostic imaging and the outlook for the future direction of the specialty.
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