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Konomatsu K, Kakisaka Y, Sato S, Kubota T, Soga T, Ukishiro K, Jin K, Mugikura S, Aoki M, Nakasato N. "Caterpillar sign" in corpus callosum associated with curvilinear pericallosal lipoma in MRI: A case report. Radiol Case Rep 2024; 19:2058-2061. [PMID: 38523692 PMCID: PMC10958131 DOI: 10.1016/j.radcr.2024.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Lipoma of the corpus callosum, also known as pericallosal lipoma, is a rare congenital brain abnormality associated with corpus callosum dysgenesis or agenesis. Two morphological types are described: tubulonodular and curvilinear, with the latter being mostly asymptomatic. We present the case of a 30-year-old woman with epilepsy, whose magnetic resonance imaging revealed a "caterpillar sign" in the corpus callosum associated with a curvilinear pericallosal lipoma. The "caterpillar sign" in the corpus callosum showed low signal intensity on magnetization prepared rapid acquisition with gradient echo, high signal on fluid-attenuated inversion recovery, and low on susceptibility-weighted imaging, possibly indicating abnormal blood vessels penetrating from the ventricle to the posterior callosal vein. We need to be conscious of this unusual finding, particularly when considering surgical intervention in the corpus callosum in cases of pericallosal lipoma, to avoid vascular complications.
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Affiliation(s)
- Kazutoshi Konomatsu
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yosuke Kakisaka
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Sato
- Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takafumi Kubota
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Temma Soga
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazushi Ukishiro
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunji Mugikura
- Division of Image Statistics, Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Departments of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Kim JH, Lee SK, Kim EH, Kim JY. Acute left iliofemoral vein thrombosis: Comparison between simple and bony May-Thurner syndrome in CT venography. Vascular 2023; 31:1230-1239. [PMID: 35762344 DOI: 10.1177/17085381221111010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the etiology of May-Thurner syndrome (MTS) with acute iliofemoral deep vein thrombosis (DVT) regarding imaging findings and clinical features. METHODS We retrospectively analyzed 57 patients with acute left iliofemoral DVT from 2015 to 2020. The diameter of left common iliac vein (LCIV) at the maximal compression site and its percent compression regarding the average diameter of the uncompressed iliac vein were recorded in central and distal portions of the LCIV according to the location in the quadrant of lumbar vertebral body. Compression was categorized into simple and bony MTS; Simple MTS as LCIV compressed by the right common iliac artery (RCIA) versus Bony MTS as LCIV by lower lumbar degenerative changes regardless of RCIA compression. Initial computed tomographic venography (CTV) regarding chronic change of LCIV such as fibrotic atrophy or cordlike obliteration, extent of thrombus, and lumbar degenerative changes were evaluated. Therapeutic effect after initial therapy was assessed in follow-up CTVs after 3-6 months. RESULTS All patients showed LCIV compression with 19 simple MTS (mean age, 42.8 ± 14.1 years [23-67 years]; 12 females; symptom for 4.4 ± 5.5 days) and 38 bony MTS (mean age, 73.0 ± 10.2 years [49-85 years]; 26 females; symptom for 5.5 ± 4.8 days). There was significant difference in age (p < .001) and no significant difference in sex or symptom duration between two groups (p = .691 and 0.415, respectively). All simple MTS showed compression only in the central LCIV and half of bony MTS showed compression in both central and distal LCIV (p < .001). Among the lumbar degenerative changes, symmetric anterolateral osteophyte (p < .001) and asymmetric osteophyte (p < .001) were significantly associated with bony MTS, but not scoliosis (p = .799), compared to simple MTS. Although there was no significant difference in chronic change of LCIV, thrombosis extent, and therapeutic effect between two groups (p > .05), chronic change of LCIV showed significant difference between single and dual compression (23.7% vs. 57.9%, p = .024) and residual thrombus after initial therapy was occurred in 21.1% of single compression and 47.4% in dual compression with non-significant trend (p = .082). CONCLUSION Bony MTS related to lumbar degenerative changes with acute iliofemoral DVT occurs in older patients, presenting more than one stenosis at LCIV, inducing more chronic change with possibly weaker therapeutic effect than simple MTS.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eu Hyun Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mizutani K, Toda M, Yajima Y, Akiyama T, Fujiwara H, Yoshida K, Jinzaki M. The analysis of the cerebral venous blood volume in cavernous sinus using 320 row multi-detector CT. Clin Neurol Neurosurg 2018; 167:11-16. [PMID: 29425742 DOI: 10.1016/j.clineuro.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/26/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Functional venous anatomy in the brain has been mostly understood from the morphological and embryological points of view and no published study has directly evaluated the blood flow volume of cerebral small veins. We developed a method to directly evaluate the relative blood volume in small venous channels using multi-detector computed tomography (CT) and applied it to evaluate the blood volume in each tributary of the cavernous sinus, which plays an important role in cerebral venous drainage. PATIENTS AND METHODS Ten patients with small brain tumors who had normal venous anatomy were included in the present study. All of them underwent preoperative 320-row multi-detector CT. After injecting the contrast bolus, we measured the Hounsfield units (HUs) at 10 time point over 60 s in each tributary of the cavernous sinus. The gamma distribution fitting to each HU enabled us to obtain a time-density curve and determine the relative venous volume in each venous channel. RESULTS In terms of blood volume, the superficial middle cerebral vein and inferior petrosal sinus were the largest inflow and outflow channels of the cavernous sinus and accounted for 36.1% and 24.7% of its inflow and outflow on average, respectively. The superior orbital vein did not contribute to the blood volume passing through the cavernous sinus in the current study. CONCLUSIONS The present study allowed us to determine the relative blood volume in each tributary of the cavernous sinus, which was very useful to understand the physiological actual venous drainage pattern concerning the cavernous sinus in normal anatomy.
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Affiliation(s)
- Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan.
| | - Yumi Yajima
- Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Abstract
Objective The drainage portion of the vein of Labbé varies, and it is difficult to predict whether the operation is likely to damage this vein. The aim of this study was to correlate the microanatomy of the vein of Labbé with digital subtraction angiography (DSA) and computed tomographic venography (CTV), in order to provide a basis for the preservation of the vein of Labbé during a supratentorial surgical approach. Methods A total of 30 human cadavers (60 sides) and 61 living patients (110 sides) were examined in this study. Each cadaver head was injected with blue latex via the superior sagittal sinus and the internal jugular veins. The venograms of each patient were obtained from the venous phases of DSA (60 sides for 36 patients) or CTV (50 sides for 25 patients). Results The patients were divided into four subgroups based on the location where a vein entered the dural sinus: the transverse sinus group, the tentorial group, the petrosal group, and the upper-transverse sinus group. The veins of Labbé in transverse sinus group and petrosal group directly entered dural sinus. The veins of Labbé in tentorial group and upper-transverse sinus group indirectly entered transverse sinus via the tentorium sinus or the upper-transverse sinus. These sinuses were meningeal veins running through two layers of the cerebral dura mater. The length of meningeal veins in these groups was 10.0 ± 7.2 mm. The veins of Labbé were mainly localized around the STP junction, which was the confluence of sigmoid sinus, transverse sinus, and superior petrosal sinus. The distance between the dural entrance of veins and the STP junction was 16.8 ± 10.2 mm. There was no significant difference in the results of the DSA and CTV examinations when compared to the observations in cadavers. Conclusions Preoperative venograms are useful to design an individualized surgical approach for the preservation of the vein of Labbé. In general, the supratentorial median approach has the least chance to damage this vein. However, when preoperative venograms show that the vein of Labbé is too close to the confluence of sinuses or the meningeal veins are too long, an alternative approach should be chosen.
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Affiliation(s)
- Qiong Fang
- Department of Anatomy, Anhui Medical College, Hefei, 230601, Anhui, China
| | - Anhong Jiang
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Wei Tao
- Department of Anatomy, School of Medicine, Anhui University of Science & Technology, 25 Dongshan Road, Huainan, 232001, China.
| | - Lin Xin
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA, Guangzhou, 510010, China
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Singh S, Ramakrishnaiah RH, Hegde SV, Glasier CM. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings. Pediatr Radiol 2016; 46:67-72. [PMID: 26358702 DOI: 10.1007/s00247-015-3458-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/13/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. OBJECTIVE To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. MATERIALS AND METHODS We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. RESULTS In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. CONCLUSION Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.
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Affiliation(s)
- Sumit Singh
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
| | - Raghu H Ramakrishnaiah
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Shilpa V Hegde
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Charles M Glasier
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
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Jiang W, Zhou J, Ke L, Li G, Tong ZH, Li WQ, Li JS. Splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography. World J Gastroenterol 2014; 20:16698-16701. [PMID: 25469039 PMCID: PMC4248214 DOI: 10.3748/wjg.v20.i44.16698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/13/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the diagnostic accuracy of computed tomographic venography (CTV) for splanchnic vein thrombosis (SVT) detection in necrotizing acute pancreatitis (AP) patients.
METHODS: Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography (DSA) within 3 d were analyzed in this retrospective comparative study. All CTV procedures were performed with a dual-source CT scanner. The presence and location of SVT were determined via blinded imaging data analyses.
RESULTS: According to the DSA results, 17 (39.5%) of the total 43 patients had SVT. The sensitivity, specificity, positive and negative predictive values of CTV for SVT detection were 100% (95%CI: 77.1%-100%), 92.3% (95%CI: 73.4%-98.7%), 89.5% (95%CI: 65.5%-98.2%) and 100% (95%CI: 82.8%-100%), respectively.
CONCLUSION: CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.
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