Plain CT vs MR venography in acute cerebral venous sinus thrombosis: Triumphant dark horse

Digge, Poornima; Prakashini, K; Bharath, K V

doi:10.4103/ijri.ijri_328_17

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…Clinical presentation of CVT may vary depending on brain parenchymal involvement, the site extension of the thrombosis, and symptom duration [ 35 ], making the outcome hardly predictable [ 13 , 20 ]. The diagnosis of CVT may be difficult, and the diagnostic delay may cause an extension of thrombosis across multiple venous sinuses or veins and worse venous infarcts leading to major long-term sequelae [ 36 , 37 ]. Delay may be even longer in patients with DCVT [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment

et al. 2023

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Purpose To develop a neuroradiological score in patients with deep cerebral venous thrombosis (DCVT), capable of assessing extension of intracranial changes and venous occlusion at diagnosis; to assess the relationship between neuroradiological and clinical features at follow-up. Material and methods In 14 patients with DCVT, we developed 2 score systems on non-enhanced and contrast-enhanced CT: Intracranial Imaging Score (IIS) and Venous Occlusion Imaging Score (VOIS). ISS considers parenchymal venous strokes, hemorrhage, mass effect, and hydrocephalus; VOIS evaluates unilateral or bilateral venous occlusion extension. Modified Rankin Scale (mRS) and vessel recanalization status were assessed at follow-up. Results At diagnosis, higher IIS was related to bilateral venous thrombosis involvement ( p 0,02; r :0,60), but parenchymal strokes were not related to venous occlusion extension (unilateral or bilateral) ( p > 0,05). Moreover, the symptoms’ onset time did not correlate with the severity scores ( p > 0,05). At follow-up, 8 out of 14 patients showed good clinical outcomes with complete recanalization and neurological improvement, 1 patient showed a poor neurological outcome, whereas 5 patients died within 1 week. Positive correlations were found between IIS and mRS ( p 0,003, r = 0,73), between IIS and vessels’ recanalization status ( p 0,002, r = 0,75), and between vessels’ recanalization status and mRS ( p < 0,001, r = 0,98). Conclusion Neuroradiological scores may enhance diagnostic accuracy, and they may have a predictive significance. In patients with DCVT, although intracranial involvement was not influenced by symptoms’ onset time or extension of venous occlusion, clinical outcome was related to both intracranial involvement and venous recanalization state. Collateral venous drainage status may counterbalance the thrombotic process improving prognosis.

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Section: Discussionmentioning

confidence: 99%

Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment

et al. 2023

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“…Acute thrombosis within the vessel lumen is usually seen as hyperattenuating material in NCCT performed in the acute phase of the disease. The increased attenuation, usually attributed to the decreased amount of water in the retracted clot and increased concentration of red blood cells and hemoglobin 4,14 , is known as cord sign or dense triangle sign. The sensitivity of this finding is reported as 63-73% in different studies 4,15,16 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis

Tayyebi

Akhavan

Shams

et al. 2020

Sci Rep

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Acute cerebral vein thrombosis is usually seen as increased attenuation in brain non-contrast computed tomography. It is so helpful to define measurable parameters for subjective evaluation of sinus thrombosis in non-enhanced brain computed tomography, especially where advanced neuroimaging techniques are not available. the purpose of this study is to evaluate the diagnostic value of venobasilar attenuation ratio and venobasilar attenuation difference in the evaluation of acute cerebral venous sinuous thrombosis in non-enhanced brain CT scan. Fifty confirmed cases of acute cerebral vein thrombosis were sex-and age-matched with 73 subjects who did not have the condition. Average venous sinus attenuation, Hounsfield to hematocrit ratio, basilar artery density, venobasilar attenuation ratio and venobasilar attenuation difference were measured. Mean attenuation was 65.8 in thrombosed and 44.9 in non-thrombosed sinuses (P < 0.0001). A cutoff absolute sinus attentuaion of 61 HU led to a sensitivity of 82%, specificity of 100% and accuracy of 92%. A cutoff ratio of 1.4 for venobasilar ratio led to a sensitivity of 100%, specificity of 78% and accuracy of 87%. A cutoff value of 24 for venobasilar difference resulted in the sensitivity of 80%, specificity of 100% and accuracy of 92%. The additional measurement of venous sinus and basilar artery attenuations and calculation of venobasilar ratio and difference can increase the sensitivity and specificity of NCCT in the diagnosis of acute cVSt. Cerebral venous sinus thrombosis (CVST) is responsible for about 0.5-1% of all strokes and occurs in about 2-5 patients per million every year 1,2. Patients exhibit a wide range of non-specific signs and symptoms, including-but not limited to-headache (the most common symptom), focal neurologic deficits, seizure and impaired level of consciousness. So, the diagnosis is usually not suspected at the initial presentation 3,4. NCCT may be the only modality available in low resource settings 5. The elevated density of the venous sinuses (dense sinus sign or cord sign) is the only direct sign of acute CVT in brain NCCT 6. It has been shown in several studies that blood density within dural veins correlates with hematocrit level 7-10 , and polycythemia is considered as a mimicker of CVST 11,12. It seems rational to define quantitative criteria for more accurate diagnosis and reduce the false positive results. The aim of this study is to evaluate NCCT in patients with and without acute CVST and determine the diagnostic value of venous sinus density, Hounsfield-hematocrit (H:H) ratio, veno-basilar (VB) ratio and VB difference in the evaluation of acute CVST. Materials and Methods patient selection. The ethics committee of Mashhad university of medical sciences approved the study (approval ID: IR.MUMS.MEDICAL.REC.1398.233) and waived the need for informed consent. In this retrospective observational study, we sought the archive of our academic hospital which is a first-level and referral neurology center, to compile the database of patients wit...

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“…Moreover, subacute thrombosis may also result in false negative diagnoses since the density of thrombi attenuated over time and becomes isodense or even hypodense after approximately 7-14 days [15,28]. Therefore, studies have evaluated whether quantitative assessment of the attenuation and attenuation values compared to haematocrit (H:H ratio) improved the diagnostic accuracy of NCCT for the diagnosis of CVT, but did not find superior sensitivity (64-95%) or superior specificity (54-100%) [13,15,[24][25][26][29][30][31]. Notably, after the administration of a contrast agent, direct/indirect signs on CT scan can still be absent in up to 30% of the CVT cases (Appendix 2) [9,[32][33][34][35][36][37][38].…”

Section: Computed Tomographymentioning

confidence: 99%

Current imaging modalities for diagnosing cerebral vein thrombosis – A critical review

Dam

Walderveen

Kroft

et al. 2020

Thrombosis Research

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Cerebral vein thrombosis (CVT) is a rare presentation of venous thromboembolism. Prompt and accurate diagnosis is essential as delayed recognition and treatment may lead to permanent disability or even death. Since no validated diagnostic algorithms exist, the diagnosis of CVT mainly relies on neuroimaging. Digital subtraction angiography (DSA) is the historical diagnostic standard for CVT, but is rarely used nowadays and replaced by computed tomography (CT) and magnetic resonance imaging (MRI). High quality studies to evaluate the diagnostic test characteristics of state of the art imaging modalities are however unavailable to date. This review provides an overview of the best available evidence regarding the diagnostic performance of CT and MRI for the diagnosis of CVT. Notably, available studies are observational, mostly small, outdated, and with a high risk of bias. Therefore, direct comparison between studies is difficult due to large diversity in study design, imaging method, reference standard, patient selection and sample size. In general, contrast-enhanced techniques are more accurate for the diagnosis of CVT then non-contrast-enhanced techniques. CT venography and MRI have been both reported to be adequate for establishing a final diagnosis of CVT, but choice of modality as used in clinical practice depends on availability, local preference and experience, as well as patient characteristics. Our review underlines the need for high-quality diagnostic studies comparing CT venography and MRI in specific settings, to improve clinical care and standardize clinical trials.

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Plain CT vs MR venography in acute cerebral venous sinus thrombosis: Triumphant dark horse

Cited by 11 publications

References 16 publications

Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment

Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment

Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis

Current imaging modalities for diagnosing cerebral vein thrombosis – A critical review

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