Prevalence of Traumatic Dural Venous Sinus Thrombosis in High-Risk Acute Blunt Head Trauma Patients Evaluated with Multidetector CT Venography
Prevalence of Traumatic Dural Venous Sinus Thrombosis in High-Risk Acute Blunt Head Trauma Patients Evaluated with Multidetector CT Venography
复制标题
DOI：
10.1148/radiol.10091565
复制
发表时间：
2010-05-01
期刊：
影响因子：
19.7
通讯作者：
Romero, Javier M.
中科院分区：
文献类型：
--
作者：
Almandoz, Josser E. Delgado;Kelly, Hillary R.;Romero, Javier M.
目的：探讨多层CT静脉成像检查闭合性颅脑损伤高危患者中创伤相关硬脑膜静脉窦血栓形成(DVST)的发生率。材料和方法：在机构审查委员会批准、HIPAA遵从性和放弃知情同意的情况下，作者对195例因硬脑膜静脉窦或颈静脉球部附近骨折或临床怀疑指数高而被认为是DVST高危患者的急诊患者进行了多层CT静脉成像检查。我们回顾了平扫CT影像和CT静脉造影中颅骨骨折、颅内出血和创伤性DVST的存在。随后在创伤性DVST患者中获得的磁共振和非增强CT图像被评估为出血性静脉梗塞。结果：140例颅骨骨折患者中，57例(40.7%)显示98个硬脑膜窦或颈静脉球血栓形成。在98个鼻窦或球部中有54个(55%)有闭塞性血栓形成。DVST仅见于那些颅骨骨折延伸至硬脑膜窦或颈静脉球的患者。在延伸至横窦、乙状窦或颈静脉球的颅骨骨折中，岩骨骨折发生创伤性DVST的风险(50%，72处骨折中的36处)高于枕骨骨折(34%，93处骨折中的32处)(P=0.044)。然而，在延伸至上矢状窦的颅骨骨折中，枕骨骨折发生创伤性DVST的风险(67%[12处骨折中的8处])高于顶骨(39%的风险[28处骨折中的11处])和额骨(24%的风险[17处骨折中的4处])(P=0.065)。外伤性DVST合并出血性静脉梗塞4例(7%)，均继发于闭塞性DVST。结论：闭合性脑外伤患者只有骨折延伸至硬脑膜静脉窦或颈静脉球时，才应行多层螺旋CT静脉成像检查。(C)RSNA，2010年
Purpose: To determine the prevalence of trauma-related dural venous sinus thrombosis (DVST) in high-risk patients with blunt head trauma who are examined with multidetector computed tomographic (CT) venography.Materials and Methods: With institutional review board approval, HIPAA compliance, and waived informed consent, the authors retrospectively studied the findings in 195 consecutive patients who presented to the emergency department with acute blunt head trauma and were examined with multidetector CT venography because they were considered to be at high risk for DVST owing to the presence of a fracture near a dural venous sinus or jugular bulb or a high index of clinical suspicion. Nonenhanced CT images and CT venograms were reviewed for the presence of skull fractures, intracranial hemorrhage, and traumatic DVST. Magnetic resonance and nonenhanced CT images subsequently obtained in patients with traumatic DVST were assessed for hemorrhagic venous infarctions. Statistical analyses were performed by using Student t and Pearson chi(2) tests.Results: Multidetector CT venography depicted thrombosis of 98 dural sinuses or jugular bulbs in 57 (40.7%) of the 140 patients with skull fractures extending to a dural sinus or jugular bulb. Fifty-four (55%) of the 98 sinuses or bulbs had occlusive thrombosis. DVST was seen in only those patients with skull fractures extending to a dural sinus or jugular bulb. Among the skull fractures extending to the transverse sinus, sigmoid sinus, or jugular bulb, those of the petrous temporal bone had a higher risk (50%, 36 of 72 fractures) of traumatic DVST than did those of the occipital bone (34% risk [ 32 of 93 fractures]) (P = .044). However, among the skull fractures extending to the superior sagittal sinus, those of the occipital bone had a higher risk (67% [ eight of 12 fractures]) of traumatic DVST than did those of the parietal (39% risk [ 11 of 28 fractures]) and frontal (24% risk [ four of 17 fractures]) bones (P = .065). Four (7%) patients with traumatic DVST had associated hemorrhagic venous infarctions, all secondary to occlusive DVST.Conclusion: In patients with blunt head trauma, multidetector CT venographic evaluation should be performed only if there is a fracture extending to a dural venous sinus or jugular bulb. (C) RSNA, 2010