Diffusion-weighted magnetic resonance in cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is a cause of stroke with obscure pa tho physiologic properties that differ from arterial stroke. Its main mechanisms of pathophysiology are the breakdown of the blood-brain barrier and the coexistence of cytotoxic and vasogenic edema. However, conventional magnetic resonance imaging (MRI) cannot differentiate between vasogenic and cytotoxic edema. Objectives: To describe the diffusion-weighted imaging (DWI) findings and characterize the clinical applications of DWI in CVT. Setting: A tertiary referral center, neurology department. Design and Methods: From November 1998 to March 2001, 14 patients (5 men, 9 women; mean age, 43 +/- 10 years) with CVT underwent DWI, conventional MRI, MR venography, or conventional cerebral angiography. Abnormal findings on DWI and conventional MRI indicated the necessity of MR venography and conventional angiography to confirm the diagnosis of CVT. Apparent diffusion coefficient (ADC) values were measured in all of the abnormal lesions with visual inspection of DWI and T2-weighted echo planar imaging. Results: Findings on DWI were grouped according to 3 patterns: (1) Heterogeneous signal intensity (SI) (10 patients) showed mixed bright high SI and low SI and the corresponding ADC values were inversely correlated to the DWI SI. The areas of prominent low S1 on DWI were reversed with adequate treatment on follow-up MRI in 1 patient. (2) Multifocal high S1 (3 patients) was similar to that observed in acute arterial stroke. The corresponding AD C values were decreased and DWI was performed in the acute stages. (3) Intravascular clot with high S1 was found with (I patient, also in heterogenous SI group) or without (1 patient) parenchymal lesions. In I patient, DWI demonstrated T2-negative and fluid attenuated inversion recovery-negative lesions without correlative symptoms. Conclusions: These data suggest that DWI with ADC maps can be used to discriminate between types of edema for tissue viability and to provide information about stages and diagnostic clues in CVT.