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01-07-2016 | Diagnostic Neuroradiology

Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis

Published in: Neuroradiology | Issue 7/2016

Abstract

Introduction

The only direct sign of sinus thrombosis on non-contrast computerized tomography (NCCT) is the hyperdense sign. The purpose of our study was to assess quantitative parameters for diagnosis of superficial venous sinus thrombosis and to compare these quantitative criteria with the current standard of qualitative evaluation.

Methods

This retrospective case–control study included 18 patients with acute superficial sinus thrombosis and 18 matched controls. Three blinded readers independently evaluated the NCCT for the presence of hyperdense sign using axial slices only followed by axial slices with multiplanar reformats. Absolute attenuation values and ratios were calculated for thrombosed and non-thrombosed sinuses: Ratio_{target sinus/lowest attenuation sinus}, Ratio_{target sinus/basilar artery}, Ratio_{target sinus/internal carotid artery}, Ratio_{target sinus/temporal lobe}, and Ratio_{target sinus/frontal lobe}.

Results

There was a significant difference in absolute attenuation values and ratios between thrombosed and non-thrombosed sinuses, with the absolute attenuation and the Ratio_{target sinus/lowest attenuation sinus} being the most differentiating. The mean attenuation for thrombosed sinuses was 69 Hounsfield units (HU) (95 % CI 65–72 HU) vs. 52 HU (95 % CI 51–54) for non-thrombosed, P < 0.0001. The mean Ratio_{target/lowest attenuation} was 1.5 (95 % CI 1.4–1.6) for thrombosed sinuses vs. 1.1 (95 % CI 1.0–1.1) for non-thrombosed, P < 0.0001. Optimal thresholds of 62 HU and 1.3 yielded sensitivities of 81 and 84 %, respectively. Hyperdense sign had a sensitivity of 63 % on axial images and 67 % with the addition of multiplanar reformats.

Conclusion

Density measurements result in substantial improvement over visual inspection in the diagnosis of superficial venous sinus thrombosis on NCCT.

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Stam J (2005) Current concepts: thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791–1798CrossRefPubMed

Tang PH, Chai J, Chan YH, Chng SM, Lim CC (2008) Superior sagittal sinus thrombosis: subtle signs on neuroimaging. Ann Acad Med Singapore 37:397–401PubMed

Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators (2004) ISCVT Investigators: prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 35:664–670CrossRefPubMed

Ferro JM, Lopes MG, Rosas MJ, Ferro MA, Fontes J (2002) Cerebral Venous Thrombosis Portuguese Collaborative Study Group (2002) Long-term prognosis of cerebral vein and dural sinus thrombosis: results of the VENOPORT study. Cerebrovasc Dis 13:272–278CrossRefPubMed

Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S (1987) The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 162:779–785CrossRefPubMed

Teasdale E (2000) Cerebral venous thrombosis: making the most of imaging. J R Soc Med 93:234–237PubMedPubMedCentral

Linn J, Pfefferkorn T, Ivanicova K, Müller-Schunk S, Hartz S, Wiesmann M, Dichgans M, Brückmann H (2009) Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. Am J Neuroradiol 30:728–735. doi:10.3174/ajnr.A1451 CrossRefPubMed

Roland T, Jacobs J, Rappaport A, Vanheste R, Wilms G, Demaerel P (2010) Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis. Clin Radiol 65:34–39. doi:10.1016/j.crad.2009.09.008 CrossRefPubMed

Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF (2011) Cerebral venous sinus density on noncontrast CT correlates with hematocrit. Am J Neuroradiol 32:1354–1357. doi:10.3174/ajnr.A250 CrossRefPubMed

10.

Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P (2013) CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. Am J Neuroradiol 34:1568–1572. doi:10.3174/ajnr.A3469 CrossRefPubMed

11.

Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed

12.

Stein J, Huerta K (2002) When looking at a non-contrast head CT, what actually appears white in an acute hemorrhagic stroke? Cal J Emerg Med 3:70–71PubMedPubMedCentral

13.

Healy JF, Nichols C (2002) Polycythemia mimicking venous sinus thrombosis. Am J Neuroradiol 23:1402–1403PubMed

Title: Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis
Publication date: 01-07-2016
Published in: Neuroradiology / Issue 7/2016
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-016-1681-2

At a glance: The STEP trials

Springer Medicine

Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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