Diffusion-weighted magnetic resonance imaging of dural sinus thrombosis

Magnetic resonance imaging (MRI) is useful to diagnose dural sinus thrombosis. However, the representative appearance of dural sinus thrombosis on diffusion-weighted MRI has not been established. This study was aimed at determining whether cytotoxic or vasogenic edema is more predominant in the affected cerebral parenchyma and assessing the time courses and prognosis of dural sinus thrombosis lesion. The studies on sixteen patients with dural sinus thrombosis who underwent diffusion-weighted MRI were retrospectively reviewed. The diagnosis was confirmed by digital subtraction angiography in 11 patients and magnetic resonance angiography in five patients. Diffusion-weighted images with echo-planar imaging were obtained using two or three b values, with the highest b value of up to 1,000 s/mm2. A region of interest was placed on an area of abnormal signal intensity to calculate apparent diffusion coefficients (ADCs). Nine of the 16 patients had lesions with an increased ADC, whereas, three of these nine patients also had lesions with a decreased ADC. Among 11 patients who underwent initial MRI within 7 days of their last episode, eight had lesions with an increased ADC, of whom three had lesions mixed with both decreased and increased ADC areas. Follow-up studies of these three patients revealed the development of hemorrhagic infarction in two and subcortical hemorrhage in one. Vasogenic edema develops more predominantly and earlier in dural sinus thrombosis, though cytotoxic edema was also associated with the pathological changes in the early phase. Decrease of ADC value is presumed to reflect severe pathological conditions and indicate possible future development of infarction or hemorrhage.