Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis

Roland, Teboh; Jacobs, Johan; Rappaport, Annelies; Vanheste, Ruben; Wilms, Guy; Demaerel, Philippe

doi:10.1016/j.crad.2009.09.008

Cited by 44 publications

(29 citation statements)

References 10 publications

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“…Computed tomography (CT) and CT venography provide generally high sensitivity for identifying thrombosis, but are less specific and less sensitive for characterizing brain injury. For example, Roland et al found that non-enhanced CT has a 73% sensitivity for correctly identifying CSVT, with a very low rate of false positives (15). CT offers the advantage of greater accessibility and speed of imaging, but involves exposure to ionizing radiation and contrast, which is of particular concern in the pediatric population.…”

Section: Diagnostic Approach: Update On Imaging Options and Best Pracmentioning

confidence: 99%

Cerebral Sinovenous Thrombosis

Ichord

2017

Front. Pediatr.

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Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30–50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease. Signs and symptoms are also age related. Seizures and altered mental status are the commonest manifestations in newborns. Headache, vomiting, and lethargy, sometimes with 6th nerve palsy, are the most common symptoms in children and adolescents. Recent multicenter cohort studies from North America and Europe have provided updated information on risk factors, clinical presentations, treatment practices, and outcomes. While systemic anticoagulation is the most common specific treatment used, there are wide variations and many uncertainties even among experts concerning best practice. The treatment dilemma is especially pronounced for neonatal CSVT. This is due in part to the higher prevalence of intracranial hemorrhage among newborns on the one hand, and the clear evidence that newborns suffer greater long-term neurologic morbidity on the other hand. With the advent of widespread availability and acceptance of acute endovascular therapy for arterial ischemic stroke, there is renewed interest in this therapy for children with CSVT. Limited published evidence exists regarding the benefits and risks of these invasive therapies. Therefore, the authors of current guidelines advise reserving this therapy for children with progressive and severe disease who have failed optimal medical management. As research focused on childhood cerebrovascular disease continues to grow rapidly, the future prospects for improving knowledge about this disorder should be good.

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Section: Diagnostic Approach: Update On Imaging Options and Best Pracmentioning

confidence: 99%

Cerebral Sinovenous Thrombosis

Ichord

2017

Front. Pediatr.

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“…2 It is accepted as a useful technique to decide on further imaging and is reported to have a sensitivity and specificity of 64.6% and 97.2%, respectively, in the detection of CVST. 3,4 The attenuation of blood on unenhanced CT scans is predominantly caused by the protein factor of hemoglobin within the red blood cells. As a result, a linear relationship existed between the attenuation of blood and hemoglobin and HCT levels in a large series of 166 patients.…”

Section: Abbreviationsmentioning

confidence: 99%

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

Buyck

Keyzer

Vanneste³

et al. 2013

AJNR Am J Neuroradiol

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“…The increased attenuation, usually attributed to the decreased amount of water in the retracted clot and increased concentration of red blood cells and hemoglobin 4,14 , is known as cord sign or dense triangle sign. The sensitivity of this finding is reported as 63-73% in different studies 4,15,16 . Quantitative measurement of attenuation is believed to be more accurate than subjective evaluation, as it can appreciate moderate increases in mean sinus density 15 .…”

Section: Discussionmentioning

confidence: 83%

Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis

Tayyebi

Akhavan

Shams

et al. 2020

Sci Rep

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Acute cerebral vein thrombosis is usually seen as increased attenuation in brain non-contrast computed tomography. It is so helpful to define measurable parameters for subjective evaluation of sinus thrombosis in non-enhanced brain computed tomography, especially where advanced neuroimaging techniques are not available. the purpose of this study is to evaluate the diagnostic value of venobasilar attenuation ratio and venobasilar attenuation difference in the evaluation of acute cerebral venous sinuous thrombosis in non-enhanced brain CT scan. Fifty confirmed cases of acute cerebral vein thrombosis were sex-and age-matched with 73 subjects who did not have the condition. Average venous sinus attenuation, Hounsfield to hematocrit ratio, basilar artery density, venobasilar attenuation ratio and venobasilar attenuation difference were measured. Mean attenuation was 65.8 in thrombosed and 44.9 in non-thrombosed sinuses (P < 0.0001). A cutoff absolute sinus attentuaion of 61 HU led to a sensitivity of 82%, specificity of 100% and accuracy of 92%. A cutoff ratio of 1.4 for venobasilar ratio led to a sensitivity of 100%, specificity of 78% and accuracy of 87%. A cutoff value of 24 for venobasilar difference resulted in the sensitivity of 80%, specificity of 100% and accuracy of 92%. The additional measurement of venous sinus and basilar artery attenuations and calculation of venobasilar ratio and difference can increase the sensitivity and specificity of NCCT in the diagnosis of acute cVSt. Cerebral venous sinus thrombosis (CVST) is responsible for about 0.5-1% of all strokes and occurs in about 2-5 patients per million every year 1,2. Patients exhibit a wide range of non-specific signs and symptoms, including-but not limited to-headache (the most common symptom), focal neurologic deficits, seizure and impaired level of consciousness. So, the diagnosis is usually not suspected at the initial presentation 3,4. NCCT may be the only modality available in low resource settings 5. The elevated density of the venous sinuses (dense sinus sign or cord sign) is the only direct sign of acute CVT in brain NCCT 6. It has been shown in several studies that blood density within dural veins correlates with hematocrit level 7-10 , and polycythemia is considered as a mimicker of CVST 11,12. It seems rational to define quantitative criteria for more accurate diagnosis and reduce the false positive results. The aim of this study is to evaluate NCCT in patients with and without acute CVST and determine the diagnostic value of venous sinus density, Hounsfield-hematocrit (H:H) ratio, veno-basilar (VB) ratio and VB difference in the evaluation of acute CVST. Materials and Methods patient selection. The ethics committee of Mashhad university of medical sciences approved the study (approval ID: IR.MUMS.MEDICAL.REC.1398.233) and waived the need for informed consent. In this retrospective observational study, we sought the archive of our academic hospital which is a first-level and referral neurology center, to compile the database of patients wit...

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Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis

Cited by 44 publications

References 10 publications

Cerebral Sinovenous Thrombosis

Cerebral Sinovenous Thrombosis

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

Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis

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