The Investigation of the Diagnostic Values of the T2WI Sequence in Cerebral Venous Sinuses Thrombosis in Comparison With 3D MRV

Cerebral venous sinus thrombosis is an important pathology with various clinical symptoms. Early detection of thrombosis is very important for the improvement of the prognosis. The aim of this study was to calculate the diagnostic value of T2-weighted sequences of magnetic resonance imaging (MRI) in detecting subacute thrombosis. All patients that were suspected of having subacute cerebral venous sinus thrombosis and were referred to the emergency center of Kashani hospital (between September 2018 and September 2019) were entered into the study. Magnetic resonance venography (MRV) and T2-weighted MRI were accomplished for each patient. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI using MRV as the reference method were calculated. A total of 630 patients were entered into the study. A positive subacute venous sinus thrombosis was detected in the MRV of 53 patients; consequently, the sensitivity of 60%, the specificity of 80%, the PPV of 21%, and the NPV of 96% were calculated. MRI was highly specific for detecting the subacute thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (specificity>94%). A substantial agreement was detected between MRI and MRV in distinguishing thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (kappa>0.6). T2-weighted MRI is a specific method in detecting cerebral venous sinus thrombosis. In a patient with signs of thrombosis in the T2-weighted sequence, additional workups are highly suggested to rule out the pathology.

Type III Kounis syndrome after administration of an echocardiography contrast agent

A dobutamine stress echocardiogram was performed in a 72-year-old woman to assess an intermediate lesion in the left anterior descending artery. After administration of the echocardiography contrast agent, she presented with an anaphylactic reaction and in that context a subacute thrombosis of a drug-eluting stent implanted 15 days before. This is a case of the so-called type III Kounis syndrome.