Multidetector Computed Tomography Venography versus Magnetic Resonance Venography in Cerebral Venous Thrombosis: A Cross-sectional Study

Abstract

Introduction: Cerebral Venous Thrombosis (CVT) is a relatively uncommon condition whose presentation is varied. The diagnostic imaging features can be subtle. The correct diagnosis of CVT relies on neuroimaging Non Contrast Computed Tomography (NCCT), CT Venography (CTV), Magnetic Resonance Imaging (MRI), MR Venography (MRV). Aim: To compare 128 slice Multidetector Computed Tomography (MDCT) venography and MRV in CVT, taking MRV as gold standard. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Gandhi Medical College, Secunderabad, Telangana, India, from October 2017 to September 2019. The study constituted of 56 patients, with clinical signs and symptoms of CVT who underwent MDCT venography and MRV. NCCT with MDCT venography was carried out on HITACHI 128 slice CT machine and MRI was performed in 1.5 tesla SIEMENS AVANTO systems. Imaging findings analysed on NCCT were hyperdense cord sign, delta sign, and multiple parenchymal hypodense lesions in bilateral parasagittal location, bilateral thalamic hypodensities, and isolated temporal bleed and on CTV signs like empty delta/empty triangle sign. Plain MRI was assessed for involved sinuses with thrombus showing loss of expected flow void with hyperintensity on T1-Weighted (T1W) and blooming on Gradient Recalled Echo (GRE). Parenchymal changes were assessed for presence of cytotoxic oedema, vasogenic oedema and haemorrhagic infarct. MRV was assessed for non visualisation of involved sinus or lack of normal flow related enhancement. Results: Among the total 56 study subjects evaluated, 48 were diagnosed to have CVT on both CTV and MRV. On CTV, 147 sinuses were found to be involved, while MRV showed involvement of 142 sinuses. One case was found to be negative for thrombus on CTV but positive on Time of Flight (TOF) MRV. Both CTV and MRV were negative for CVT in seven patients. The sensitivity and specificity of NCCT in diagnosing CVT was found to be 60% and 87%, respectively. Conclusion: The parenchymal changes in CVT were better evaluated on MRI. Venous abnormalities were better depicted in MRI as loss of flow voids in T1, T2 and with dark signal on GRE. Haemorrhagic bleeds were easily evaluated on MRI with 100% sensitivity of GRE sequence. CTV was easier to interpret, showed better and faster depiction of sinuses, with thin section reformatted images and showed higher spatial resolution compared to MRV.

Keywords

• cord sign
• delta sign
• diffusion weighted imaging
• neuroimaging
• venous abnormalities