THE UTILITY OF 3T HIGH-RESOLUTION MRI IN THE DETECTION OF BRAIN HERNIATIONS INTO THE DURAL VENOUS SINUSES OR CALVARIUM

Abstract

Objective: Brain parenchyma herniation into the dural venous sinus or calvarium is considered a rare anatomical variation. The aim of this study is to evaluate the frequency, localization, and clinical and radiological findings of brain herniation into dural venous sinus and/or calvarium with high resolution 3 Tesla magnetic resonance imaging in a large group of patients.

Material and Methods: A total of 6825 cranial magnetic resonance images containing pre-contrast and post-contrast 3D T1-weighted sequences as well as conventional sequences were retrospectively evaluated. The presence of brain herniation into dural sinuses or calvarium, location and size of herniation, signal intensity of the adjacent brain parenchyma, presence of arachnoid granulation adjacent to the herniation were noted.

Results: Brain herniation into DVS/ calvarium was determined in 50 patients (0.73%). The detected brain herniations were most frequently associated with the temporal lobe parenchyma (n=37, 68.5%), and 91% (n=49) extended into the transverse sinuses. All brain herniations were detected both by 3D T1-weighted and 3D T2-weighted sequences; however, 29 (53.7%) of the 54 herniations were not detected by conventional sequences.

Conclusion: High resolution MRI sequences are superior to conventional sequences in detecting brain herniation into DVS/ calvarium. Patients with brain herniation into DVS/ calvarium may present with heterogeneous symptomatology, and the relationship between brain herniation and symptoms is controversial.

Keywords

• meningeal herniation
• arachnoid
• sinus thrombosis
• magnetic resonance imaging

Dural Venöz Sinüsler ya da Kalvarum İçerisine Beyin Herniasyonlarının Tespitinde Yüksek Rezolüsyonlu 3T MRG Yararı

Abstract

Amaç: Dural venöz sinüsler ya da kalvaryum içerisine beyin parankimi herniasyonu, nadir bir anatomik varyasyon olarak kabul edilmektedir. Bu çalışmanın amacı, geniş bir hasta rubunda, yüksek çözünürlüklü 3 Tesla Manyetik rezonans görüntüleme ile, dural venöz sinüs içerisine ve/veya kalvaryuma beyin parankimi herniasyonunun sıklığı, lokalizasyonu, klinik ve radyolojik bulgularını değerlendirmektir.

Gereç ve Yöntemler: Kontrast öncesi ve kontrast sonrası 3D T1 ağırlıklı sekansları ve aynı zamanda konvansiyonel sekansları içeren toplam 6825 beyin Manyetik rezonans görüntüleme incelemesi retrospektif olarak değerlendirildi. Dural sinüs içerisine beyin herniasyonu varlığı, herniasyonun yerleşimi ve boyutu, komşu beyin parankiminin sinyal intensitesi, herniasyon komşuluğunda araknoid granülasyon varlığı kaydedildi.

Bulgular: 50 hastada (%0.73) dural venöz sinus/kalvaryum içerisine beyin herniasyonu saptandı. Saptanan beyin herniasyonları en sık temporal lob parankimi ile ilişkili (n=37, %68,5) ve %91’i (n=49) transvers sinüs içerisine uzanım gösteriyordu. Tüm beyin herniasyonları hem 3D T1 ağırlıklı hem de 3D T2 ağırlıklı sekanslarda saptandı; buna karşın 54 herniasyonun 29’unda (%53.7) konvansiyonel sekanslarla herniasyon saptanmadı.

Sonuç: Dural venöz sinüs/kalvarum içerisine beyin parankimi herniasyonunu saptamada, yüksek çözünürlüklü MRG sekansları konvansiyonel sekanslara göre üstündür. Dural venöz sinüs/kalvarum içerisine beyin parankimi herniasyonunu hastalarda heterojen semptomatoloji ile ortaya çıkabilir ve semptomlar ile beyin parankim herniasyonu arasındaki ilişki tartışmalıdır.

Keywords

• meningeal herniasyon
• araknoid
• sinus trombozu
• manyetik rezonans görüntüleme

References

1. 1. Battal B, Hamcan S, Akgun V, Sari S, Oz O, Tasar M et al. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance. Eur Radiol. 2016;26(6):1723-31.
2. 2. Sade R, Ogul H, Polat G, Pirimoglu B, Kantarcı M. Brain herniation into the transverse sinuses’ arachnoid granulations in the pediatric population investigated with 3 T MRI. Acta Neurol Belg. 2019;119(2):225–31.
3. 3. Malekzadehlashkariani S, Wanke I, Rüfenacht DA, San Millán D. Brain herniations into arachnoid granulations: about 68 cases in 38 patients and review of the literature. Neuroradiology. 2016;58(5):443–57.
4. 4. Çoban G, Yıldırım E, Horasanlı B, Çifçi BE, Ağıldere M. Unusual cause of dizziness: occult temporal lobe encephalocele into transverse sinus. Clin Neurol Neurosurg. 2013;115(9):1911-3.
5. 5. Karatag O, Cosar M, Kizildag B, Sen HM. Dural sinus filling defect: intrasigmoid encephalocele. BMJ Case Rep. 2013;5;2013:bcr2013201616.
6. 6. Kakisaka Y, Sato S, Takayanagi M, Nakasato N. Epilepsy case with focal cerebral herniation into the sigmoid sinus. Neurol Sci. 2016;37(3):487–8.
7. 7. Battal B, Castillo M. Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity. Neuroradiol J. 2014;27(1):55–62.
8. 8. Ogul H, Guven F, Izgi E, Kantarci M. Evaluation of giant arachnoid granulations with high-resolution 3D-volumetric MR sequences at 3T. Eur J Radiol. 2019;121:108722.

9. 9. Gozgec E, Ogul H, Izgi E, Kantarci M. Tissue damage in herniated brain parenchyma into giant arachnoid granulations: demonstration with high resolution MRI. Acta Radiol. 2021;62(6):799-806
10. 10. Suzuki H, Takanashi J, Kobayashi K, Nagasawa K, Tashima K, Kohno Y. MR Imaging of idiopathic intracranial hypertension. Am J Neuroradiol. 2001;22(1):196-9.
11. 11. Leach JL, Fortuna RB, Jones B V, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. RadioGraphics 2006;26(suppl_1):S19-41.
12. 12. Chan WC, Lai V, Wong YC, Poon WL. Focal brain herniation into giant arachnoid granulation: A rare occurrence. Eur J Radiol Extra. 2011;78(2):e111-3.
13. 13. Asadi H, Morokoff A, Gaillard F. Occult temporal lobe encephalocoele into the transverse sinus. J Clin Neurosci 2015;1;22(7):1202-4.
14. 14. Kocyigit A, Herek D, Balci YI. Focal herniation of cerebral parenchyma into transverse sinus. J Neuroradiol 2015;42(2):126-7.
15. 15. Liebo GB, Lane JJI, Van Gompel JJ, Eckel LJ, Schwartz KM, Lehman VT. Brain herniation into arachnoid granulations: clinical and neuroimaging features. J Neuroimaging. 2016;26(6):592-8.
16. 16. Leach JL, Jones B V, Tomsick TA, Stewart CA, Balko MG. Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease. Am J Neuroradiol. 1996;17(8):1523-32.
17. 17. Trimble CR, Harnsberger HR, Castillo M, Brant-Zawadzki M, Osborn AG. “Giant” arachnoid granulations just like CSF?: NOT!! Am J Neuroradiol. 2010; 31(9):1724-8.
18. 18. Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Takahashi M et al. Normal structures in the intracranial dural sinuses: delineation with 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo imaging sequence. Am J Neuroradiol. 2002;1;23(10):1739–46.
19. 19. Wolbach SB. Multiple Hernias of the Cerebrum and Cerebellum, due to intracranial Pressure. J Med Res 1908;19(1):153-74.
20. 20. Watane GV, Patel B, Brown D, Taheri MR. The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension. J Comput Assist Tomogr. 2018;42(2):282-5.