Cerebral Venous Thrombosis and Multidetector CT Angiography: Tips and Tricks

Abstract

Because of the great diversity of clinical features, its unforeseeable evolution, and a small proportion of cases that will worsen in the acute phase, cerebral venous thrombosis must be diagnosed as early as possible so that specific treatment can be started, typically transcatheter thrombolysis or systemic anticoagulation. Unenhanced computed tomography (CT) is usually the first imaging study performed on an emergency basis. Unenhanced CT allows detection of ischemic changes related to venous insufficiency and sometimes demonstrates a hyperattenuating thrombosed dural sinus or vein. Helical multidetector CT venography with bolus power injection of contrast material and combined use of two-dimensional and three-dimensional reformations (maximum intensity projection, integral display, and volume rendering) provides exquisite anatomic detail of the deep and superficial intracranial venous system and can demonstrate filling defects. However, common variants of the sinovenous system should not be mistaken for sinus thrombosis. A comprehensive diagnostic approach facilitates imaging of cerebral venous thrombosis with multidetector CT.

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: a Case Report

“…The investigators suggested that anticoagulation was safe, even in patients with cerebral hemorrhage. 19 However, the present case was not an intraparenchymal hemorrhage, but SAH. We considered that intravenous heparin would deteriorate SAH and preferred to initiate low doses of fractionated heparin, 60 mg once a day.…”

“…Systemic anticoagulation is the first line treatment for CVT because of its efficacy, safety, and feasibility. 19 In a further placebocontrolled trial, 60 patients were randomized to either lower molecular weight heparin followed by warfarin or placebo. 20 The anticoagulated patients had better outcomes than controls, but the difference was not statistically significant.…”

CT Density Measurement and H:H Ratio Are Useful in Diagnosing Acute Cerebral Venous Sinus Thrombosis

“…The classic sign of acute CVST on unenhanced CT images is an increase in attenuation of the occluded sinus, reflecting a newly formed thrombus. 2 It is accepted as a useful technique to decide on further imaging and is reported to have a sensitivity and specificity of 64.6% and 97.2%, respectively, in the detection of CVST. 3,4 The attenuation of blood on unenhanced CT scans is predominantly caused by the protein factor of hemoglobin within the red blood cells.…”

Computed Tomography of Brain in Polycythemia

“…Magnetic resonance (MR) imaging and time-of-flight venography can confirm the presence or absence of venous sinus thrombosis in such conditions. Recently, CT venography using multidetector CT has been recommended in cases of cerebral venous thrombosis especially when the MR findings are inconclusive or MR is unavailable/ contraindicated [7]. Acute subarachnoid or subdural hemorrhage layered along the falx or tentorium cerebelli may give rise to false hyperdensity to the dural venous sinuses.…”