CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(03): 280-284
DOI: 10.4103/ijri.IJRI_328_17
Neuroradiology & Head and Neck Imaging

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

Poornima Digge
Department of Radio-Diagnosis, Pramukhswami Medical College, Karamsad, Gujarat, India
,
Koteshwar Prakashini
Department of Radio-Diagnosis, Kasturba Medical College (KMC), Manipal, Karnataka, India
,
K V Bharath
Department of Anaesthesia and Critical Care, Kasturba Medical College (KMC), Manipal, Karnataka, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Context: Most patients with cerebral venous sinus thrombosis (CVST) present with nonspecific signs and symptoms and are likely to undergo nonenhanced head computed tomography (NCT) at presentation, which may show a normal report in up to two-thirds of patients. However, in case of acute thrombosis, sensitivity of diagnosing CVST is high as sinuses are hyperdense. Though magnetic resonance imaging (MRI) is considered the imaging modality of choice for diagnosing CVST, it is not universally available in an acute setting. Aims: To evaluate whether increased attenuation in cerebral venous sinuses in acute condition can be used to diagnose acute CVST and to determine its diagnostic value. Materials and Methods: The study involves two independent groups. One group of patients with sinus thrombosis were confirmed by MR venography (group A). The other group included patients without sinus thrombosis (group B). The HU (CT attenuation), hemoglobin (HGB), hematocrit (HCT), and H: H (HU: HCT) ratio of both groups were compared. Thirty-six patients (59 thrombotic sinuses) were studied in group A and 40 in group B. Statistical Analysis: Average HU and H: H ratio were compared using two-tailed t-test, and linear regression analysis was used to assess correlation between HCT and HU. Results: Average HU (73.7 vs 48.6) and H: H ratio values were higher in group A patients compared to group B (P < 0.05). Linear regression analysis showed positive correlation between HGB and HCT with HU among both the groups (P < 0.05). Conclusions: Our study demonstrates that acute CVST can be diagnosed using HU values in NCT.



Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol 2007; 6: 162-70
  • 2 Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F. ISCVT Investigators. Causes and predictors of death in cerebral venous thrombosis. Stroke 2005; 36: 1720-5
  • 3 Poon CS, Chang JK, Swarnkar A, Johnson MH, Wasenko J. Radiologic diagnosis of cerebral venous thrombosis: Pictorial review. AJR Am J Roentgenol 2007; 189: S64-75
  • 4 Saposnik G, Barinagarrementeria F, Brown DRJr, Bushnell CD, Cucchiara B, Cushman M. et al Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: 1158-92
  • 5 Qu H, Yang M. Early imaging characteristics of 62 cases of cerebral venous sinus thrombosis. Exp Ther Med 2013; 5: 233-6
  • 6 Ozsvath RR, Casey SO, Lustrin ES, Alberico RA, Hassankhani A, Patel M. Cerebral venography: comparison of CT and MR projection venography. AJR Am J Roentgenol 1997; 169: 1699-707
  • 7 Janjua N. Cerebral angiography and venography for evaluation of cerebral venous thrombosis. J Pak Med Assoc 2006; 56: 527-30
  • 8 Rizzo L, Crasto SG, Rudà R, Gallo G, Tola E, Garabello D. et al Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol Med 2010; 115: 313-25
  • 9 Wasay M, Azeemuddin M. Neuroimaging of cerebral venous thrombosis. J Neuroimaging 2005; 15: 118-28
  • 10 Besachio DA, Quigley 4rd EP, Shah LM, Salzman KL. Noncontrast Computed Tomographic Hounsfield unit evaluation of Cerebral venous thrombosis: A quantitative evaluation. Neuroradiology 2013; 55: 941-5
  • 11 Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H: H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol 2013; 34: 1568-72
  • 12 Coutinho J, de Bruijn SF, Deveber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev 2011; 10: CD002005
  • 13 Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am J Neuroradiol 2011; 32: 1354-7
  • 14 Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: Frequency and significance in 76 cases of dural sinus thrombosis. Radiology 1987; 162: 779-85
  • 15 Alsafi A, Lakhani A, Carlton Jones L, Lobotesis K. Cerebral Venous Sinus Thrombosis, a Nonenhanced CT Diagnosis?. Radiol Res Pract 2015; 2015: 581437