Value of spontaneous hyperdensity of cerebral venous thrombosis on helical CT

Garetier, Marc; Rousset, J.; Pearson, Ernesto; Tissot, V.; Gentric, Jean-Christophe; Nowak, Emmanuel; Ferré, Jean-Christophe; Timsit, Serge; Salem, Douraı̈ed Ben

doi:10.1177/0284185113513977

Cited by 22 publications

(25 citation statements)

References 25 publications

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“…The finding of hyperattenuation in a thrombosed sinus is in accordance with previously reported findings [11,12,[19][20][21]. In previously published material different cutoffs for HU have been proposed ranging from 62 to 70 [12,[19][20][21].…”

Section: Discussionsupporting

confidence: 90%

“…CVST affects fewer than two individuals per 100,000 persons/year [4,5] with headache as the most common symptom, present in up to 89% of patients [2,[6][7][8][9][10]. The clinical diagnosis is difficult, with radiological investigation required to confirm the diagnosis [10][11][12][13][14][15][16]. Correct clinical suspicion of CVST is complicated by the fact that the condition frequently causes symptoms also seen in more common diagnoses, such as stroke or brain tumors.…”

Section: Introductionmentioning

confidence: 99%

“…Patient age is one important consideration when deciding imaging strategy, since computed tomography (CT) exposes the patient to ionizing radiation [18]. Previous studies have reported on the diagnostic utility of nonenhanced head computed tomography (neCT) to suspect CVST due to high density in the sinuses [11,12,[19][20][21][22]. Despite previous reports suggesting the applicability of neCT to accurately identify acute CVST, other methods such as magnetic resonance imaging (MRI) or CT venography (CTV) are recommended to verify the diagnosis of CVST.…”

Section: Introductionmentioning

confidence: 99%

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Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort

2020

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Background: Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT) in patients with nontraumatic headache and clinically suspected CVST. Methods: A retrospective consecutive series of patients referred 2013-2015 for radiology were evaluated. Eligible patients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography (CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All CTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT (2017-2019). Results: Less than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining 99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the patient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of CVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65) venous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion written in referral, 10%). Conclusions: Despite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon. Evaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems reasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading neCT for other indications.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort

2020

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“…Currently, non‐enhanced CT remains the first line investigation for blunt head trauma in most emergency settings . Skull fractures overlying a dural venous sinus and increased sinus density on non‐enhanced CT have been associated with DVST …”

Section: Introductionmentioning

confidence: 99%

“…7,8 Skull fractures overlying a dural venous sinus and increased sinus density on non-enhanced CT have been associated with DVST. [9][10][11][12][13][14][15][16][17] It has not been investigated whether patients with intraluminal sinus gas may have a higher likelihood of DVST in the setting of trauma. Intrasinus gas has been noted in prior case reports [18][19][20][21][22][23] and we postulate that it may be a marker of sinus injury, suggesting an increased risk of sinus thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Traumatic dural venous sinus gas predicts a higher likelihood of dural venous sinus thrombosis following blunt head trauma

Dixon

Kavnoudias

et al. 2019

J Med Imag Rad Onc

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Introduction The aim of this study was to assess the association between intrasinus gas and dural venous sinus thrombosis (DVST) in patients with blunt head trauma. Methods One hundred and two consecutive patients with blunt head trauma imaged with non‐enhanced CT and CT head venography at our institution between 1 July 2011 and 30 June 2016 were included. Image review was performed by two independent reviewers to assess for the presence of intrasinus or perisinus gas and DVST. Skull fractures involving a dural venous sinus, sinus hyperdensity, extraaxial haematoma, and/or extrinsic dural venous sinus compression were also recorded. Univariate and multivariate analyses estimated the associations between the imaging variables and DVST. Results Thirty‐seven cases of DVST were confirmed with CT venography: 10 (27.0%) occlusive, and 27 (73.0%) non‐occlusive. We detected 24 cases of intrasinus gas, all occurring with skull fractures. Gas localized to the sinus involved by the fracture in 23 (95.8%) of 24 cases. Additional gas within a contiguous sinus was present in nine (37.5%) cases. The association between intrasinus gas and DVST of the respective sinus was statistically significant (OR: 11.3, CI: 3.9–32.9, P < 0.0001). DVST was also significantly associated with the presence of a skull fracture (P = 0.04), fractures involving the sigmoid sinus (P = 0.0001), and sinus hyperdensity (P < 0.0001). Conclusion Traumatic intrasinus gas is associated with DVST in patients with blunt head trauma. Its detection on non‐enhanced CT examinations in the emergency care setting infers a higher risk of DVST and should prompt consideration of CT venography.

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Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases

Jesuyajolu¹,

Olukoya²,

Moti³

2022

Clinical Case Reports

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Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done.Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female-to-male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty-nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.

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Value of spontaneous hyperdensity of cerebral venous thrombosis on helical CT

Cited by 22 publications

References 25 publications

Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort

Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort

Traumatic dural venous sinus gas predicts a higher likelihood of dural venous sinus thrombosis following blunt head trauma

Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases

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