PMC5296347_01
Left parasagittal images in (A) T2, (B) T1, and (C) T1 + C weighting. These depict the enlargement of the vertebral venous plexus/sinus resulting in the compression and dorsal elevation of the spinal cord. Enlargement of this plexus is present from the cranial aspect of C2 to the caudal aspect of C6.
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F1
Magnetic resonance angiography was acquired using both 2D (TR 5,569, TE 118.3) and 3D time of flight techniques (3D Sliding Interleaved Ky-single interleaved ky TR 27, TE 6.7) and reformatted using maximum intensity projection. MRI of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 (Figure 1) and extending cranially on both sides of the spinal cord to cranial aspect of C1.
Transverse images at the level of the mid body of C2, in (A) T2, (B) T2*, (C) T1, and (D) T1 + C weighting. The arrow indicates the signal void on the T2* image.
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F2
On transverse sequences, moderate spinal cord compression was associated with marked dilation of the vertebral venous sinuses (Figure 2). T2, and iso to hyperintense on T1 (Figure 2). The same area showed a signal void on T2*. Extending caudally to the mid body of C2 at the site of maximal dilation of the vertebral venous sinuses, the signal pattern was heterogenous on T2*, T2, and more uniform hyperintense signal on T1 (Figure 2). Postgadolinium, there was minimal enhancement noted in the right vertebral venous sinus (Figures 2 and 3).
Reconstruction of the vertebral venous plexus (asterisks), vertebral veins (arrowheads), and internal carotid arteries (arrows). The intensity of the red signal indicates contrast enhancement, while the blue signal is less contrast enhanced. The heterogeneity of the blue signal in the plexus indicates heterogenous material in the sinus or turbulent flow.
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F3
Postgadolinium, there was minimal enhancement noted in the right vertebral venous sinus (Figures 2 and 3). The changes in the vertebral sinuses were suggestive of incompletely formed thrombi in both the left and right vertebral sinuses at the level of C1 with subsequent dilation of the sinuses at the level of C2 (Figure 3).