Lisette van Dam

General discussion and summary 13 195 establishing a final diagnosis in complex cases, such as in patients with suspected recurrent CVT and in patients in whom venous sinuses are affected by brain tumours or after intracranial surgery. In Chapter 8 , we described a 52-year-old female patient who presented at the Emergency Department with a mild headache and blurry vision and was suspected of an acute CVT. Her medical history included a craniotomy for right sided parieto-occipital meningioma. Imaging with CT and MR venography showed no opacification of the superior sagittal sinus and both transverse sinuses suspected of thrombosis, but of unknown age. However, as MR- NCTI showed no high signal intensity, acute CVT was excluded and anticoagulant treatment discontinued. The cerebral sinus occlusion was most likely due to chronic CVT or as a result of residual meningioma tissue and follow-up MRI showed no new abnormalities, nor had the patient new adverse events during 12 months of follow-up. MRDTI also excluded an acute thrombus in a patient with aortic thrombosis. This case was described in Chapter 9 . It concerned a 43-year- old male patient known with severe hypertension and renal failure, who presented with abdominal pain for several months. CT angiography showed a large extensive circumferential wall thrombosis in an abdominal aortic aneurysm. The patient was referred for MRDTI scan, since it was unknown whether the thrombus concerned an acute or chronic thrombosis, and the treating doctors were hesitant to start anticoagulant treatment because of the high bleeding risk. MRDTI excluded an acute thrombus, and anticoagulant treatment was not started. These two case reports represent the first cases in which MR-NCTI techniques were used to guide anticoagulant treatment in suspected acute CVT and aortic thrombosis. CTPA is the diagnostic test of choice for the diagnosis of acute PE. Moreover, CTPA parameters of right heart dysfunction, including right ventricle to left ventricle diameter ratio (RV/LV ratio) and pulmonary artery trunk diameter, can be used in the initial risk stratification of acute PE patients. A novel CT technique, called CT pulmonary perfusion (CTPP), has an added value to CTPA reading as it shows the pulmonary perfusion and thus possible functional impact of an acute PE. CTPP has previously be shown to improve the diagnosis of PE when added to CTPA. We hypothesized that CTPP could also improve the prediction of adverse outcomes of PE. In Chapter 10, we evaluated the correlation between perfusion defect score (PDS) on CTPP and both clinical presentation and adverse short-term outcomes in hemodynamically stable PE patients. In this analysis, we were not able to show an association between PDS and clinical presentation such as chest pain, dyspnea and haemoptysis. We did show that PDS was correlated to the need for reperfusion therapy and PE-related mortality.