Cerebral Venous Thrombosis: MR Black-Blood Thrombus Imaging with Enhanced Blood Signal Suppression

G. Wang; X. Yang; J. Duan; N. Zhang; M.M. Maya; Y. Xie; X. Bi; X. Ji; D. Li; Q. Yang; Z. Fan

doi:10.3174/ajnr.A6212

Abstract

BACKGROUND AND PURPOSE: The residual blood flow artifact is a critical confounder for MR black-blood thrombus imaging of cerebral venous sinus thrombosis. This study aimed to conduct a validation of a new MR black-blood thrombus imaging technique with enhanced blood signal suppression.

MATERIALS AND METHODS: Twenty-six participants (13 volunteers and 13 patients) underwent conventional imaging methods followed by 2 randomized black-blood thrombus imaging scans, with a preoptimized delay alternating with nutation for tailored excitation (DANTE) preparation switched on and off, respectively. The signal intensity of residual blood, thrombus, brain parenchyma, normal lumen, and noise on black-blood thrombus images were measured. The thrombus volume, SNR of residual blood, and contrast-to-noise ratio for residual blood versus normal lumen, thrombus versus residual blood, and brain parenchyma versus normal lumen were compared between the 2 black-blood thrombus imaging techniques. Segmental diagnosis of venous sinus thrombosis was evaluated for each black-blood thrombus imaging technique using a combination of conventional imaging techniques as a reference.

RESULTS: In the volunteer group, the SNR of residual blood (11.3 ± 2.9 versus 54.0 ± 23.4, P < .001) and residual blood-to-normal lumen contrast-to-noise ratio (7.5 ± 3.4 versus 49.2 ± 23.3, P < .001) were significantly reduced using the DANTE preparation. In the patient group, the SNR of residual blood (16.4 ± 8.0 versus 75.0 ± 35.1, P = .002) and residual blood-to-normal lumen contrast-to-noise ratio (12.4 ± 7.8 versus 68.8 ± 35.4, P = .002) were also significantly lower on DANTE-prepared black-blood thrombus imaging. The new black-blood thrombus imaging technique provided higher thrombus-to-residual blood contrast-to-noise ratio, significantly lower thrombus volume, and substantially improved diagnostic specificity and agreement with conventional imaging methods.

CONCLUSIONS: DANTE-prepared black-blood thrombus imaging is a reliable MR imaging technique for diagnosing cerebral venous sinus thrombosis.

ABBREVIATIONS:

BTI: black-blood thrombus imaging
CE: contrast-enhanced
CNR: contrast-to-noise ratio
CVT: cerebral venous sinus thrombosis
DANTE: delay alternating with nutation for tailored excitation
TSE: turbo spin-echo
SPACE: sampling perfection with application-optimized contrasts by using different flip angle evolution

Footnotes

G. Wang and X. Yang have contributed equally to this work.
This work was supported by National Institutes of Health/National Heart, Lung, and Blood Institute 1 R01 HL147355 and Beijing Natural Science Foundation (No. 17L20253), The National Science Foundation of China (No. 91749127 and 81830056), and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support. (ZYLX201706).
Disclosures: Zhaoyang Fan—RELATED: Grant: National Institutes of Health/National Heart, Lung, and Blood Institute 1 R01 HL147355. Qi Yang—RELATED: Grant: Beijing Natural Science Foundation (No. 17L20253), National Science Foundation of China (No. 91749127 and 81830056), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201706). Guan Wang—RELATED: China Medical University as a visiting scholar.

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