Current imaging modalities for diagnosing cerebral vein thrombosis – A critical review

Abstract

Cerebral vein thrombosis (CVT) is a rare presentation of venous thromboembolism. Prompt and accurate diagnosis is essential as delayed recognition and treatment may lead to permanent disability or even death. Since no validated diagnostic algorithms exist, the diagnosis of CVT mainly relies on neuroimaging. Digital subtraction angiography (DSA) is the historical diagnostic standard for CVT, but is rarely used nowadays and replaced by computed tomography (CT) and magnetic resonance imaging (MRI). High quality studies to evaluate the diagnostic test characteristics of state of the art imaging modalities are however unavailable to date. This review provides an overview of the best available evidence regarding the diagnostic performance of CT and MRI for the diagnosis of CVT. Notably, available studies are observational, mostly small, outdated, and with a high risk of bias. Therefore, direct comparison between studies is difficult due to large diversity in study design, imaging method, reference standard, patient selection and sample size. In general, contrast-enhanced techniques are more accurate for the diagnosis of CVT then non-contrast-enhanced techniques. CT venography and MRI have been both reported to be adequate for establishing a final diagnosis of CVT, but choice of modality as used in clinical practice depends on availability, local preference and experience, as well as patient characteristics. Our review underlines the need for high-quality diagnostic studies comparing CT venography and MRI in specific settings, to improve clinical care and standardize clinical trials.

Cerebral Venous Thrombosis: A Comprehensive Review

“…Non-contrast CT shows direct signs like dense clot sign (visualization of thrombus in the cerebral veins and sinuses) and string or cord sign (string or cord-like density indicating CSVT); as well as indirect signs like cerebral edema, mass effect, and intracranial hemorrhage that can range from small juxtacortical lesions to subarachnoid hemorrhage and large hemorrhagic infarcts. Contrast-enhanced CT shows direct signs like empty delta sign (a low-attenuated center surrounded by a triangular area of contrast enhancement) and indirect signs, similar to non-contrast CT [38, 39] (Fig. 3).…”

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

“…Magnetic resonance black-blood thrombus imaging, as a native contrast thrombus MRI technique, has been recently evaluated in the setting of suspected CVT yielding sensitivity of 100% and specificity of 96%, even up to the level of individual venous segments (52).…”

Trombosis Venosa Cerebral: Consideraciones Actuales

“…19 Principalmente hay una mejora de contraste de morfología y extensión variables, como el realce de contraste de la hoz y del tentorio cerebral. 19 Venografía por TC (VTC): Es una TC helicoidal, desarrollada mediante la administración de contraste con optimización de tiempo, 6,22 que muestra el defecto de llenado, un mayor reforzamiento de la pared venosa y el drenaje venoso colateral aumentado (figura 2). 14 Es útil en estadios subagudos o crónicos de la enfermedad debido a las densidades variables dentro del vaso trombosado.…”

“…La venografía por TC después de la administración de un agente de contraste yodado muestra un defecto de llenado en ambos senos transversales (flechas). 22 Figura 3. Imágenes de proyección de intensidad máxima de la venografía por tomografía computarizada que muestra.…”

“…14 Así mismo, mediante técnicas mejoradas en 2D y 3D se puede proporcionar imágenes anatómicas detalladas de la circulación venosa cerebral superficial y profunda, libres de sobre proyecciones de los huesos y del parénquima cerebral (figura 3). 22 El diagnóstico correcto mediante esta técnica varía según el sitio de la trombosis, siendo aproximadamente el 99% para las trombosis de senos venosos y el 88% para las trombosis de venas corticales. 2,11 Junto con la VRM son modalidades de imagen neurovascular, y son las más eficientes en el contexto de la TVC.…”