Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses

Abstract

Background and purpose: The diagnosis of cerebral venous and sinus thrombosis (CVST) as a rare but important cause of stroke is challenging. We aimed to investigate the diagnostic value of multidetector-row CT angiography (MDCTA) as a fast and cost-effective imaging tool in diagnosing CVST.

Materials and methods: Nineteen patients who presented with clinical symptoms of a possible CVST were included. All patients had received both MDCTA and MR imaging with venous MR-angiography. Three blinded readers were asked to identify the cerebral sinuses and veins in MDCTA and to evaluate the presence of CVST in MDCTA. Consensus reading with interpretation of the MR imaging served to establish the definite diagnosis.

Results: The consensus reading revealed CVST in 10 of the 19 patients. With MDCTA, the venous sinuses could be identified in 99.2% and the cerebral veins in 87.6% of cases. The sensitivity and specificity of MDCTA for the diagnosis of CVST were 100%.

Conclusion: Our study demonstrates that MDCTA provides excellent sensitivity and specificity for the diagnosis of CVST. Further studies are needed to evaluate the diagnostic potential of MDCTA in specific subsets of the general entity of CVST such as cortical venous thrombosis, thrombosis of the cavernous sinus, and thrombosis of the internal cerebral veins.

Fig 1.

Sagittal (A) and coronal (B, C) sections of MIP reformations in a 22-year-old woman (patient 11) demonstrate the normal venous anatomy: superior sagittal sinus (thin arrow), the inferior sagittal sinus (arrowheads), the straight sinus (thick arrow), and the transverse sinuses (curved arrows). No venous pathologic condition was present in this patient. The MDCTA was performed on a 64-row-detector system.

Fig 2.

Coronal (A, B) and sagittal (D) sections of MIP reformations of a MDCTA performed on a 4-row-detector system in a 54-year old woman (patient 10) with an acute thrombosis of the superior sagittal sinus (thick arrows) and the left transverse sinus (thin arrow) show filling defects in the respective sinuses. Axial T1- (C) and PD-weighted (E) MR images demonstrate hyperintense signal intensity in the thrombosed left transverse sinus (C, arrow) and the superior sagittal sinus (E, arrow).

Fig 3.

A 23-year-old male patient presenting with headache, amnestic aphasia, and visual disturbances (patient 4). MR imaging and MDCTA, performed on a 4-row-detector system, demonstrate a thrombosis of the left transverse (arrows) and sigmoid sinuses. A, Axial T1-weighted MR depicts hyperintense, thrombotic material in the left transverse sinus. B, C, 2D time-of-flight MR venography shows no flow void in the left transverse and sigmoid sinuses. D, Coronal sections of MIP reformations demonstrate a filling defect in the left transverse sinus.

Fig 4.

MDCTA and MR images of a 29-year-old female patient (patient 7) presenting with headache and seizures. Transversal sections of MIP reformations of the MDCTA (A, D) demonstrate filling defects in the left transverse (arrowheads) and sigmoid sinuses (arrow). Axial PD-weighted (B) and coronal fluid-attenuated inversion recovery (FLAIR) images (C) depict hyperintense, thrombotic material in the left sigmoid sinus. E, F, 2D time-of-flight MR venography shows no flow void in the left transverse and sigmoid sinuses.