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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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