Cerebral venous thrombosis : Measuring thrombi and sinuses

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http://urn.fi/URN:NBN:fi:hulib-201507282502
Title: Cerebral venous thrombosis : Measuring thrombi and sinuses
Author: Hannikainen, Heikki
Other contributor: Helsingin yliopisto, Lääketieteellinen tiedekunta, Kliininen laitos
University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine
Helsingfors universitet, Medicinska fakulteten, Institutionen för klinisk medicin
Publisher: Helsingfors universitet
Date: 2014
Language: eng
URI: http://urn.fi/URN:NBN:fi:hulib-201507282502
http://hdl.handle.net/10138/44894
Thesis level:
Discipline: Neurology
Neurologia
Neurologi
Abstract: Background and purpose: Cerebral venous thrombosis (CVT) is a rare, but serious disease, commonly occurring in young to middle-aged women. It is not yet known whether sinus size and shape confers a risk for thrombosis and whether clot size is correlated with recanalization rates, and because there is no established method for measuring sinus or clot size, we decided to develop one. Patients and methods: CVT patients with 3-D magnetic resonance imaging done early for diagnosis and follow-up imaging around 6 months or later were recruited. Age and sexmatched (1:2) control subjects were patients with various benign headache problems who underwent 3D MRI for excluding CVT or other acute structural disease. All major sinuses were measured in size (area and diameter). All detected clots underwent similar measurement (volume, area and length). Measurements were done with Osirix-software. Results: 25 CVT patients (17 females and 8 males) and 50 control subjects were measured. Volume of the thrombus was either dissolved or reduced in all except one case. Sinus area in CVT patients in follow-up imaging was slightly smaller compared to healthy subjects (P=0.052-0.170). Thrombus volumes were bigger (P=0.009) but also dissolved more effectively in women, with no difference in sex-groups in follow-up imaging. Residual clot volume was bigger in older patients (P=0.007). Other factors did not strongly correlate with thrombus volume. Measurement reproducibility with two individual investigators was good, with best interrater correlation of over 95% in volume measures. Conclusions: This is the first attempt in establishing a volumetric measurement of cerebral sinuses and clots. The methodology may help in estimating probability of recanalization and in trials with interventions such as local thrombolysis and thrombectomy.


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