Pericerebral fluid collection: Differentiation of enlarged subarachnoid spaces from subdural collections with color Doppler US

PURPOSE: To determine if the cerebral cortical vein sign seen on magnetic resonance (MR) images can be used with color Doppler ultrasound (US) to differentiate enlarged subarachnoid space from subdural collection. MATERIALS AND METHODS: Eighteen infants with pericerebral fluid collection were prospectively examined with color Doppler US and MR imaging. Patients were classified into two groups: group A, with positive cortical vein sign (visualization of color-coded cortical veins that cross fluid collections at cerebral convexities); and group B, without the sign. RESULTS: Positive cortical vein sign was seen at US in 12 patients (group A): nine with benign enlargement of subarachnoid spaces, two with brain atrophy, and one with meningococcal meningitis. The veins were displaced and embedded within the echogenic pia-arachnoid that surrounds the brain or were trapped in the subarachnoid spaces between the neomembrane and cortical surface (group B, negative cortical vein sign) in four patients with meningitis, two victims of child abuse, and one patient with leukemia. Findings from subsequent MR imaging confirmed the color Doppler US findings. CONCLUSION: Color Doppler US depiction of the cortical vein sign appears to be as effective as MR imaging in differentiating enlargement of the subarachnoid fluid space from subdural effusion.