Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study

Abstract

BackgroundTransverse sinus stenosis (TSS) is common among patients with cerebral venous sinus thrombosis. No previous studies have reported on double-track sign detected on axial Gd-enhanced T1WI in TSS. This study aimed to determine the sensitivity and specificity of the double-track sign in the detection of TSS.MethodsWe retrospectively reviewed medical records of 383 patients with transverse sinus thrombosis (TST) and 30 patients with normal transverse sinus from 5 participating hospitals in china from January 2008 to June 2014. 167 feasible transverse sinuses included in this study were categorized into TSS (n = 76), transverse sinus occlusion (TSO) (n = 52) and transverse sinus normal (TSN) groups (n = 39) according to imaging diagnosis on digital subtraction angiography (DSA) or magnetic resonance venography (MRV). Double-track sign on axial Gd-enhanced T1WI was compared among the three groups. Sensitivity and specificity of double-track sign in detection of TSS were calculated, with final imaging diagnosis of TSS on DSA or MRV as the reference standard.ResultsOf 383 patients with TST recruited over a 6.5-year period, 128 patients were enrolled in the study, 255 patients were excluded because of insufficient clinical data, imaging finding and delay time, and 30 matched patients with normal transverse sinus were enrolled in the control group. Therefore, double-track sign assessment was conducted in 167 available transverse sinuses of 158 patients. Of the 76 sinuses in TSS group, 51 had double-track sign. Of the other 91 sinuses in TSO and TSN groups, 3 had a false-positive double-track sign. Thus, double-track sign on axial Gd-enhanced T1WI was 67.1% (95% CI 55.3–77.2) sensitive and 96.7% (95% CI 89.9–99.1) specific for detection of TSS.ConclusionsThe double-track sign on axial Gd-enhanced T1WI is highly specific and moderate sensitive for detection of TSS. Nevertheless, it could be a direct sign and might provide an early clue for TSS.

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

“…Overall, the variability of shapes and dimension of the dye spreading reported in the literature for corpses may be referred to some factors, as follows. The costotransverse ligaments showed different anatomical configuration and relationships along the vertebral column [ 6 , 28 ]. Indeed, the posterior costotransverse ligament is absent/rudimentary between T1 and T6, very well developed at the T7–T10, and undetectable at the T11–T12, which could negatively influence the diffusion within the paravertebral spaces at these lower levels for dye injection at the T5 level [ 9 , 11 , 12 , 21 , 22 ].…”

Value of double - track sign in differentiating primary from thrombosed transverse sinus stenosis in patients presumed to have idiopathic intracranial hypertension

“…In addition, unenhanced MRI T1WI is unreliable for the detection of dural venous thrombosis [34] . In the study of, the signal intensity of thrombus on T1WI and T2WI was changed with the age of thrombosis, while, the signal intensity of the double-track sign on axial Gd-enhanced T1WI persisted throughout the different stages of TS thrombosis (acute, sub-acute and chronic), and it disappeared only in totally occluded or totally recanalized sinus, accordingly, the double-track sign usually indicate the TST [11] . For this reason; the double-track sign is considered as a direct sign in the identification of TST.…”

“…In the present study, double track sign is detected on axial Gd-enhanced MRI in 87.5% of the thrombosed sinuses, and the double track sign is not documented in the normal sinuses. The double track sign presented with two hyperintense linear tracts of contrast agent, separated by the hypointense signal of non-contrast thrombus within dural sinus [11] . The double track sign is thought to result from the interaction between the damaged cellular wall and the thrombosis, the injury of endothelial cells with associated increased permeability of sinus wall [11] .…”

“…The double track sign presented with two hyperintense linear tracts of contrast agent, separated by the hypointense signal of non-contrast thrombus within dural sinus [11] . The double track sign is thought to result from the interaction between the damaged cellular wall and the thrombosis, the injury of endothelial cells with associated increased permeability of sinus wall [11] . CT is sensitive to detect acute dural sinus thrombosis [32] , but it has no role in the chronic stage of thrombosis [33] .…”

“…It was observed that patients with thrombosis showed an abnormal region of double-track pattern on gadolinium (Gd) – enhanced T1WI within the dural sinus. The double track sign presented with two hyperintense linear tracts of contrast agent separated by the hypointense signal of non-contrast thrombus within dural sinus [11] .…”