ECHOCONTRAST-ENHANCED TRANSCRANIAL COLOR-CODED SONOGRAPHY FOR THE DIAGNOSIS OF TRANSVERSE SINUS VENOUS THROMBOSIS

Background and Purpose Early diagnosis of cerebral transverse sinus ve nous thrombosis (TSVT) is difficult because of nonspecific and variabl e clinical presentations. Therefore, we evaluated the diagnostic value of transcranial color-coded duplex sonography (TCCS) after administra tion of an echocontrast-enhancing agent (cTCCS) in clinically suspecte d TSVT. Methods We examined 14 patients (6 men, 8 women; mean age, 48 years; range, 18 to 70 years) with signs and symptoms suggestive of ce rebral TSVT. Color-coded signals from the contralateral transverse sin us were displayed transtemporally before and after injections of an ec hocontrast agent by TCCS. Sonographic findings were correlated with MR I and MR venography (MRV). Results Before echocontrast enhancement. TC CS displayed color Doppler signals in 7 of 28 transverse sinus. Echoco ntrast TCCS obtained sufficient color signals in 27 of 28 transverse s inus. Thus, diagnostic confidence was achieved in all but I patient. I n 13 patients, cTCCS identified 3 cases with symmetrical blood flow in the transverse sinus, which was confirmed by MRV. Accordingly, asymme try of venous blood flow was correctly assessed by cTCCS in the other 10 patients. In 6 of these 10 patients, cTCCS demonstrated residual co lor flow signals, which on MRI/MRV corresponded to partial TSVT (4 cas es) and to hypoplasia (1 case) of the transverse sinus. One case of co mplete thrombotic occlusion of the transverse sinus was missed by cTCC S because of color Doppler signals originating from an adjacent dural fistula. Echocontrast TCCS diagnosis of occlusion of a transverse sinu s was confirmed by MRI/MRV in all cases (aplasia of transverse sinus, n = 1; complete TSVT, n = 3). Systolic peak flow velocities were signi ficantly decreased in hypoplastic or partially occluded transverse sin us (9.4 +/- 4.0 cm/s) and significantly increased contralaterally (28. 4 +/- 6.5 cm/s) with respect to patients with symmetrical appearance o f the transverse sinus (17.5 +/- 1.9 cm/s) (P < .05). Conclusions TCCS examination of the cerebral venous system is difficult without contra st media application and almost useless for the study of TSVT. However , cTCCS is of practical value in the initial workup of patients with c linically suspected TSVT and may provide further insight fur follow-up studies in view of monitoring the recanalization.