Early imaging characteristics of 62 cases of cerebral venous sinus thrombosis

Abstract

This study aimed to evaluate the early imaging characteristics of cerebral venous sinus thrombosis (CVST). A retrospective analysis was conducted of the clinical and imaging data of 62 patients with CVST diagnosed by magnetic resonance imaging (MRI) and/or digital subtraction angiography (DSA). In the 62 cases, MRI (1.5 T MRI) and magnetic resonance venography (MRV) examinations were conducted for 56 cases, and 54 of these were definitely diagnosed as CVST cases. Their MRI manifestations presented punctiform and sheet-like hemorrhagic cerebral infarction and extensive brain edema while partial cases presented cerebral ventricle dilation. In addition, MRI, MRV and DSA examinations were conducted synchronously for 2l cases. Among the 20 patients whose MRI and MRV examinations were positive, 19 cases were positive by DSA examination and the coincidence rate of the two was 95.00%. The clinical manifestations of CVST lack specificity. MRI combined with MRV examination is the preferred method of diagnosing CVST.

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

“…Among the 20 patients whose MRI and MRV were positive, 19 cases were positive for DSA and the K agreement rate between the two techniques was 0.95. 24 The quality of the evidence was judged as very low because all studies were observational with a high risk of bias.…”

Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases

“…However, it has to be stressed that even in the course of CVT involving large venous sinuses, sometimes no evident lesions within the brain can be found in CT imaging. 1,8,9 This was the case in 2 of our patients with CVT of transverse and sigmoid sinuses in whom no visible changes within brain parenchyma were detected either in emergency CT or any of the follow-up neuroimaging examinations. In another 2 subjects, emergency CT examinations were reported normal since no cerebral lesions were visible initially.…”

“…In 3 of our patients, it was the contrast enhanced MRI which ultimately diagnosed CVT. Parenchymal changes are better visible in MRI than in CT. 9 In addition to better detection of brain lesions, MRI allows for an unambiguous differentiation of venous from arterial strokes, since the latter show diffusion restriction in DWI. 16 Another advantage of MRI is its capability to image thrombosed veins and venous sinuses, even in the examinations without contrast application, with greater sensitivity than unenhanced CT examinations, and in the case of thrombosis of cortical veins with greater sensitivity than CT venography.…”

“…18,19 At present, DSA, which is still regarded as the gold standard for diagnosing vascular pathologies, is only rarely performed in CVT because of its invasiveness. 9 It is only used in diagnostically difficult cases. In our study, DSA was performed in 2 cases.…”

“…To visualize the whole extent of the disease, an initial CT examination of the brain is often followed by other imaging examinations such as CT venography, magnetic resonance (MR) with or without contrast injection, MR venography (MRV) and, very rarely, digital subtracted angiography (DSA). 8,9 Accurate diagnosis of CVT allows for quick implementation of treatment and better prognosis for the patient. 10 It has to be stressed that despite the growing knowledge of this disease, the diagnosis of CVT is still commonly overlooked and delayed due to the remarkable diversity of clinical symptoms and neuroimaging appearance, and thus still remains a diagnostic challenge for both clinicians and radiologists.…”