CT Density Measurement and H:H Ratio Are Useful in Diagnosing Acute Cerebral Venous Sinus Thrombosis

Buyck, P-J; Keyzer, Frederik De; Vanneste, Dominique; Wilms, Guy; Thijs, Vincent; Demaerel, Philippe

doi:10.3174/ajnr.a3469

Cited by 78 publications

(92 citation statements)

References 10 publications

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“…The concentration of hemoglobin is one of the determining factors as it has a linear correlation with the attenuation while platelets and atheromatous or cellular debris are known to decrease the attenuation of the thrombus on CT [9], [12]–[14], [34]–[36]. Studies on this topic, however, are experimental, animal studies, or investigations of the venous sinus thrombus.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation

et al. 2014

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IntroductionWe related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT (NCCT) to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke.MethodsWe histopathologically investigated 22 thrombi retrieved after mechanical thrombectomy in acute stroke patients. First, thrombi were classified as fresh, lytic or organized. Second, percentages of red blood cells (RBCs), platelets and fibrin and number of red, white (respectively RBCs or platelets outnumbering other components with ≥15%) or mixed thrombi were compared between large artery atherosclerosis (LAA), cardioembolism, dissection and unknown subtype. Third, correlation between attenuation and RBCs, platelets and fibrin was calculated using Pearson's correlation coefficients (r).ResultsThrombi were fresh in 73% (n = 16), lytic in 18% (n = 4) and organized in 9% (n = 2). The stroke cause was LAA in eight (36%), cardioembolism in six (27%), dissection in three (14%), and unknown in five (23%) patients. LAA thrombi showed the highest percentage RBCs (median 50 (range 35–90)), followed by dissection (35 (20–40), p = 0.05), cardioembolism (35 (5–45), p = 0.013) and unknown subtype (25 (2–40), p = 0.006). No differences in platelets (p = 0.16) and fibrin (p = 0.52) between subtypes were found. LAA thrombi were classified as red or mixed (both n = 4), cardioembolisms as mixed (n = 5) or white (n = 1) and dissection as mixed (n = 3). There was a moderate positive correlation between attenuation and RBCs (r = 0.401, p = 0.049), and weak negative correlations with platelets (r = −0.368, p = 0.09) and fibrin (r = −0.073, p = 0.75).ConclusionsThe majority of cerebral thrombi is fresh. There are no differences in age of thrombi between subtypes. LAA thrombi have highest percentages RBCs, cardioembolism and unknown subtype lowest. No relationship exists between subtype and platelets or fibrin percentages. We found a correlation between the RBC-component and thrombus attenuation, which improves validation of thrombus attenuation on NCCT as an imaging biomarker for stroke management.

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Section: Discussionmentioning

confidence: 99%

Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation

et al. 2014

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“…CT‐venography is a decent and less expensive alternative to MRI for the diagnosis of CVT, but it is inferior for the visualization of brain parenchymal lesions . Unenhanced CT is generally insufficient for the diagnosis, although a recent small study reported promising results on the diagnostic accuracy of CT density measurement of the dural sinuses in acute CVT .…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

Cerebral venous thrombosis

2015

Journal of Thrombosis and Haemostasis

124

115

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To cite this article: Coutinho JM. Cerebral venous thrombosis. J Thromb Haemost 2015; 13 (Suppl. 1): S238-S44.Summary. Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults and children. In contrast to venous thromboembolism, women are affected three times more often than men. Baseline symptoms can vary considerably between patients, but most present with headache, seizures, or focal neurological deficits. Patients can be diagnosed with magnetic resonance imaging, computerized tomographyvenography, or catheter angiography, although the latter is rarely required anymore. Approximately 30-50% of patients have an intracerebral hemorrhage, which can range from a small juxtacortical hemorrhage to large space-occupying lesions. Based on limited evidence from clinical trials, the primary therapy for CVT is anticoagulation with heparin. Uncontrolled studies have shown promising results for the use of endovascular treatment in severely affected patients, but these studies require confirmation in prospective clinical trials. In patients who develop clinical and radiological signs of impending herniation decompressive surgery can be both life saving and result in a good functional outcome.

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“…A positive correlation and significant association have been established between hemoglobin (hematocrit) levels and the attenuation of blood on unenhanced CT images [14,15]. The increase in attenuation (i.e., radiodensity) is caused by clot retraction, as the process of clot retraction includes the elimination of water, which increases the concentration of red blood cells and hemoglobin [16]. Based on the autopsy findings, the high attenuation areas in the present cases' digestive tracts corresponded to the location of the clotting.…”

Section: Discussionmentioning

confidence: 98%

Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: A comparison of postmortem computed tomography and autopsy findings

et al. 2015

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CT Density Measurement and H:H Ratio Are Useful in Diagnosing Acute Cerebral Venous Sinus Thrombosis

Cited by 78 publications

References 10 publications

Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation

Histopathologic Composition of Cerebral Thrombi of Acute Stroke Patients Is Correlated with Stroke Subtype and Thrombus Attenuation

Cerebral venous thrombosis

Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: A comparison of postmortem computed tomography and autopsy findings

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