Neuroimaging of Cerebral Venous Thrombosis (CVT) – Old Dilemma and the New Diagnostic Methods

Abstract

SummaryBackgroundCerebral venous thrombosis is a relatively uncommon neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. The pathogenesis is multifactorial and the disease may occur at any age. CVT is often associated with nonspecific symptoms. Radiologists play a crucial role in patient care by providing early diagnosis through interpretation of imaging studies.Underdiagnosis or misdiagnosis can increase the risk of severe complications, including hemorrhagic stroke or death. The purpose of this study is to investigate radiological and clinical characteristics of cerebral venous thrombosis (CVT) based on material from 34 patients under care of our hospital.Material/MethodsA total of 34 patients were diagnosed with CVT from August 2009 until March 2015. A clinical and radiological database of patients with final diagnosis of CVT was analyzed.ResultsPatient group included 22 women and 12 men at a mean age of 48.7 years (ranging from 27 to 77 years). In the study group 8 patients (23.5%) suffered from hemorrhagic infarction, whereas 16 patients (47%) were diagnosed with venous infarction without hemorrhage. Thirty patients (88%) had transverse sinus thrombosis.ConclusionsAccording to our study, CVT was more prevalent in women. Transverse sinus was the most common location. Among all age groups, the highest prevalence was seen in the fifth decade (n=14). Contrast-enhanced CT and MR venography were the most sensitive imaging modalities.

Diagnostic Performance of MRI Sequences for Evaluation of Dural Venous Sinus Thrombosis

“…In the assessment of DVST, DWI has been shown to be helpful in the absence of a T2-weighted GRE sequence [19], but it has shown low sensitivity for the visualization of clots [7,17]; these findings are similar to the results of the present study. DWI can be useful in the evaluation of abnormal findings associated with DVST, such as parenchymal infarction [20] or susceptibilityrelated signal occurring next to the thrombosed vein [19].…”

A Rare Case of Pulmonary Tuberculosis Predisposing to Cerebral Venous Thrombosis

“…After 15 days, thrombus becomes isointense on T1W1 and hyperintense in T2W1 images. [11][12][13] According to the EFNS guidelines, the recommended treatment of CVT is anticoagulation with low molecular weight heparin followed by oral warfarin for 3 months, 14 since TB is a transient reversible risk factor. Low molecular weight heparin is superior to unfractionated heparin in CVT, in terms of efficacy and safety.…”

Serial Arterial Spin Labeling May Be Useful in Assessing the Therapeutic Course of Cerebral Venous Thrombosis: Case Reports

“…1,3,6) Although development of modern diagnostic modality including MRV and CTV have achieved early diagnosis and treatment of the disease resulted with decreasing neurological sequelae, current mortality and morbidity rate of this disease is not negligibly low and the outcome of CVST remains largely unpredictable. 2,4,5) Anticoagulation therapy using heparin is considered to be one of the current standard treatments, 2) however, the data are still lacking regarding the adequate modality to monitor the treatment effect.…”

“…1–3) It’s mortality rate was around 30–50% according to the early reports, 4) however, the recent neuroimaging technique enabled fast and reliable diagnostic accuracy against the disease and its mortality rate has dropped to 5–9.4%. 5) The diagnosis of CVST can be most easily established based on the findings of magnetic resonance (MR) venography, fluid-attenuation inversion recovery (FLAIR), computed tomography venography (CTV) and conventional angiography.…”

“…5) The diagnosis of CVST can be most easily established based on the findings of magnetic resonance (MR) venography, fluid-attenuation inversion recovery (FLAIR), computed tomography venography (CTV) and conventional angiography. 2,3,6) However, precise evaluation of the treatment efficacy of CVST is still somewhat challenging. MR venography (MRV) or CTV may provide arterial and venous morphological information, but it is not suitable for elucidating the development of collateral circulation and the improvement of the brain perfusion.…”