| Purpose 34 cases of cerebral venous sinus thromboses (CVST) were retrospectively analyzed so as to investigate some clinical aspects of the disease and especially their radiological characteristics that might facilitate an early diagnosing. Methods 1. The affected sinuses and their locations were listed out, and an evaluation was conducted on the MRI signal evolution of the thrombi based on SE T1WI sequence in the early stages, in order to see whether a chronological order of the affected sinuses could be inferred from. 2. An observation was made about the signal change at the jugular foramina (with or without the upper top of the internal jugular veins), compared with a contrast group of 20 normal cases, using Wilcoxon rank sum test, so as to evaluate whether such changes could be of some hints for diagnosing of lateral sinus thrombosis and be integral parts of CVST diagnosis when thrombotic involment was confermed. 3. We also compared the difference of the consequent brain impairment between those cases that the SSSs and the lateral sinuses were continuously affected and those patients only single side of lateral sinuses were involved, using Fisher exact probabilities in 2×2 table test, so as to provide evidence in a pathophysiological view for the chronological order of thrombolic involvement of the major sinuses. 4. The occurrence and its radiological features of cerebral hemorrhage as part of the consequent brain impairment arising from CVST were also described in this paper, which might play an important role in CVST diagnosing. Results 1. In most cases dural sinuses thromboses continuously involved more than one sinus or uninterruptedly extended in one sinus, most often affected the whole SSS and at the same time at least one side of the lateral sinuses, when the SSS was more often than not the earliest location appearing hyperintensity in T1WI images in the early stages. 2. For those thromboses affecting the sigmoid sinuses, the MR signal at the ipsilateral jugular foramina (with or without the involvement of the upper top of the internal jugular veins) in T1WI and T2WI images was respectively brighter than that of the normal control group, with P<0.0005. The elevated signal often made a clear difference from the normal opposite. 3. The occurrences rates of brain impairment in the temporal-occipital lobes were different for thromboses affecting the SSSs and the lateral sinuses and for those purely affecting the lateral sinuses, with P~0.0004. 4. The occurrence rate of hemorrhage was high in the consequent brain impairment of CVST, with an early presentation and various sorts of shapes including crescent, fusiform, elliptic, patchy, and banding appearance, often in a multiple and coexisting manner, and often assembling the "stripes of a zebra" when they seemed to be parallelly arranged and sometimes mimicking the "horse's hoofs" when they merged and extended. Conclusion 1. MRI was superior to CT in CVST diagnoses, MRI plain scans conbined with MRV should be the front line examination methods with regard to CVST. 2. Most often the thrombus continuely extended and involved multiple sinuses or uninterrupted extended in one sinus. 3. The thrombi often extended following the direction of the blood flow, the place where the thrombi originally occurred was the location most easy to induce the corresponding brain impairment, while the place affected by the extending thrombi later on was not easy to cause brain impairment. 4. Abnormal signal changes in the jugular foramina provided strong hints for diagnosing of sigmoid sinuses thromboses and were integral parts of CVST diagnoses when thrombotic involment was evidence-basedly conformed. 5. Hemorrhage in the consequent brain impairment of CVST was of pathognomonic characteristics for diagnosis of CVST in its high occurrence rate, early presentation, and various morphological manifestations.
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