PEDİYATRİK SEREBRAL VENÖZ TROMBUS VAKALARINDA KONTRASTSIZ BT: HU DEĞERLERİ TANISAL GÜCÜ ARTTIRABİLİR Mİ?
Abstract
Giriş: Serebral venöz sinüs trombozu (SVST) morbidite ve mortalitesi yüksek, çocukluk çağında görece daha nadir izlenen bir patolojidir. Görüntüleme yöntemlerindeki son gelişmeler ile SVST’nin tanı sıklığı artmış ve bu hastalık ile perinatal dönemdeki beyin hasarı arasındaki ilişkiler daha görünür hale gelmiştir. SVST nonspesifik nörolojik bulgular ile ortaya çıktığından tanı alma süresi uzayabilmektedir. Bu çalışmada tromboze serebral sinüslerden Hounsfield unit (HU) ölçümleri yapılarak SVST tanısında eşik HU değerleri tespit edilmesi ve HU değerlerinin hematokrit düzeyleri ile potansiyel ilişkisinin tespit edilmesi amaçlanmaktadır.
Gereç ve yöntem: Manyetik rezonans venografi (MRV) incelemesi, kontrastsız beyin BT incelemesi ve hematokrit değerleri olan çocuk hastalar çalışmaya dahil edilmiştir. 16 adet tromboze serebral venden HU değeri ölçülmüştür. 30 pediatrik hasta ile kontrol grubu oluşturulmuştur. Kontrol grubunda serebral sinüslerin orta kesiminde HU ölçümü gerçekleştirilip sadece bir sinüsün ortalama değeri veri olarak kaydedilmiştir. Kontrol grubunda hematokrit değerleri ile HU ölçümleri arasındaki ilişkiyi belirlemek ve bu ilişkinin yaş gruplarına göre değişimini incelemek amacıyla, katılımcılar üç yaş grubuna ayrılmıştır.
Bulgular: SVST’den ölçülen HU değeri kontrol grubu HU değerine kıyasla anlamlı olarak yüksek izlenmiştir (61’e karşı 48,6, p < 0.01). Kontrol grubu 0-1 yaşa ait ortalama sinüs HU değeri, tüm kontrol grubuna ait ortalama HU değerine göre anlamlı olarak düşüktür (44’e karşı 48,6, p < 0.05). Serebral venöz sinüslerdeki HU değerinin 60 ve üzeri bulunmasının %98 duyarlılık ve %80 özgüllük ile tromboz varlığını öngörebildiği bulunmuştur (AUC = 0.912).
Sonuç: Dural sinüslerden, kontrastsız beyin BT kullanılarak ölçülen yüksek HU değerleri SVST tanısında yüksek özgüllüğe sahiptir.
Keywords
References
- 1. Prabhudesai A, Shetty S, Ghosh K, Kulkarni B. Dysfunctional fibrinolysis and cerebral venous thrombosis. Blood Cells Mol Dis. 2017;65:51-5.
- 2. de la Vega Muns G, Quencer R, Ezuddin NS, Saigal G. Utility of Hounsfield unit and hematocrit values in the diagnosis of acute venous sinus thrombosis in unenhanced brain CTs in the pediatric population. Pediatr Radiol. 2019;49(2):234-9.
- 3. Poon CS, Chang JK, Swarnkar A, Johnson MH, Wasenko J. Radiologic diagnosis of cerebral venous thrombosis: pictorial review. AJR Am J Roentgenol. 2007;189(6 Suppl):S64-75.
- 4. Dlamini N, Billinghurst L, Kirkham FJ. Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am. 2010;21(3):511-27.
- 5. Kristoffersen ES, Harper CE, Vetvik KG, Faiz KW. Cerebral venous thrombosis - epidemiology, diagnosis and treatment. Tidsskr Nor Laegeforen. 2018;138(12).
- 6. Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am J Neuroradiol. 2011;32(7):1354-7.
- 7. Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology. 1987;162(3):779-85.
- 8. Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol. 2013;34(8):1568-72.
- 9. Cobelli R, Zompatori M, De Luca G, Chiari G, Bresciani P, Marcato C. Clinical usefulness of computed tomography study without contrast injection in the evaluation of acute pulmonary embolism. J Comput Assist Tomogr. 2005;29(1):6-12.
- 10. Goldstein M, Quen L, Jacks L, Jhaveri K. Acute abdominal venous thromboses--the hyperdense CT sign. J Comput Assist Tomogr. 2012;36(1):8-13.
NONENHANCED CT IN PEDIATRIC CEREBRAL VENOUS TROMBOSIS CASES: CAN HU VALUES INCREASE DIAGNOSTİC EFFICACY
Abstract
Introduction: Cerebral venous sinus thrombosis (CVST) is a rare neurological disease presenting with high morbidity and mortality . CVST is increasingly diagnosed and is a disease that causes childhood and neonatal paralysis. Since it presents with nonspecific neurological findings in childhood, diagnosis time may be prolonged. Non-contrast computerized tomography (CT) is performed as the first imaging method in the emergency department. The aim of this study was to determine the new threshold value with Hounsfield unit (HU) measurements from thrombosed sinus and to evaluate its relationship with hematocrit in pediatric patients.
Methods: Children with Magnestic Resonance Venography, CT examinations and hematocrit values were included. HU values of 16 trombosed cerebral sinuses were recorded. Control group consists of 30 healthy children. In control group, HU values were measured from the mid portion of cerebral sinuses and one mean value were recorded. Also, in orter to define possible relations between HU and hematoctrit values, children in control group were divided into three subgroups according to age.
Results: The HU value measured from the CVST was significantly higher than the control group (61 versus 48,6, p < 0.01 ). The mean sinus HU value of the control group of 0-1 years was significantly lower than the mean HU value of the whole control group (44 versus 48,6, , p < 0.05). When the success of sinus HU measurement in the diagnosis of CVST was evaluated; The cut-off value, above 60 HU was found to be useful with 98% sensitivity and 80% specificity.
Conclusion: High attenuation values in the dural sinuses have high sensitivity for CVST.
Keywords
References
- 1. Prabhudesai A, Shetty S, Ghosh K, Kulkarni B. Dysfunctional fibrinolysis and cerebral venous thrombosis. Blood Cells Mol Dis. 2017;65:51-5.
- 2. de la Vega Muns G, Quencer R, Ezuddin NS, Saigal G. Utility of Hounsfield unit and hematocrit values in the diagnosis of acute venous sinus thrombosis in unenhanced brain CTs in the pediatric population. Pediatr Radiol. 2019;49(2):234-9.
- 3. Poon CS, Chang JK, Swarnkar A, Johnson MH, Wasenko J. Radiologic diagnosis of cerebral venous thrombosis: pictorial review. AJR Am J Roentgenol. 2007;189(6 Suppl):S64-75.
- 4. Dlamini N, Billinghurst L, Kirkham FJ. Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am. 2010;21(3):511-27.
- 5. Kristoffersen ES, Harper CE, Vetvik KG, Faiz KW. Cerebral venous thrombosis - epidemiology, diagnosis and treatment. Tidsskr Nor Laegeforen. 2018;138(12).
- 6. Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am J Neuroradiol. 2011;32(7):1354-7.
- 7. Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology. 1987;162(3):779-85.
- 8. Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol. 2013;34(8):1568-72.
- 9. Cobelli R, Zompatori M, De Luca G, Chiari G, Bresciani P, Marcato C. Clinical usefulness of computed tomography study without contrast injection in the evaluation of acute pulmonary embolism. J Comput Assist Tomogr. 2005;29(1):6-12.
- 10. Goldstein M, Quen L, Jacks L, Jhaveri K. Acute abdominal venous thromboses--the hyperdense CT sign. J Comput Assist Tomogr. 2012;36(1):8-13.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original research article |
| Authors | |
| Publication Date | January 1, 2022 |
| Submission Date | February 17, 2021 |
| Published in Issue | Year 2021 Volume: 54 Issue: 3 |
