Original Article

The Investigation of the Diagnostic Values of the T2WI Sequence in Cerebral Venous Sinuses Thrombosis in Comparison With 3D MRV

Abstract

Cerebral venous sinus thrombosis is an important pathology with various clinical symptoms. Early detection of thrombosis is very important for the improvement of the prognosis. The aim of this study was to calculate the diagnostic value of T2-weighted sequences of magnetic resonance imaging (MRI) in detecting subacute thrombosis. All patients that were suspected of having subacute cerebral venous sinus thrombosis and were referred to the emergency center of Kashani hospital (between September 2018 and September 2019) were entered into the study. Magnetic resonance venography (MRV) and T2-weighted MRI were accomplished for each patient. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI using MRV as the reference method were calculated. A total of 630 patients were entered into the study. A positive subacute venous sinus thrombosis was detected in the MRV of 53 patients; consequently, the sensitivity of 60%, the specificity of 80%, the PPV of 21%, and the NPV of 96% were calculated. MRI was highly specific for detecting the subacute thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (specificity>94%). A substantial agreement was detected between MRI and MRV in distinguishing thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (kappa>0.6). T2-weighted MRI is a specific method in detecting cerebral venous sinus thrombosis. In a patient with signs of thrombosis in the T2-weighted sequence, additional workups are highly suggested to rule out the pathology.  

1. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-8.
2. De Bruijn S, De Haan R, Stam J. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry. 2001;70(1):105-8.
3. Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664-70.
4. Khandelwal N, Agarwal A, Kochhar R, Bapuraj J, Singh P, Prabhakar S, et al. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. American Journal of Roentgenology. 2006;187(6):1637-43.
5. Rizzo L, Crasto SG, Rudà R, Gallo G, Tola E, Garabello D, et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol Med. 2010;115(2):313-25.
6. Provenzale JM, Kranz PG. Dural sinus thrombosis: sources of error in image interpretation. American Journal of Roentgenology. 2011;196(1):23-31.
7. Patel D, Machnowska M, Symons S, Yeung R, Fox A, Aviv R, et al. Diagnostic performance of routine brain MRI sequences for dural venous sinus thrombosis. American Journal of Neuroradiology. 2016;37(11):2026-32.
8. Soleau SW, Schmidt R, Stevens S, Osborn A, MacDonald JD. Extensive experience with dural sinus thrombosis. Neurosurgery. 2003;52(3):534-44.
9. Walecki J, Mruk B, Nawrocka-Laskus E, Piliszek A, Przelaskowski A, Sklinda K. Neuroimaging of Cerebral Venous Thrombosis (CVT)–Old Dilemma and the New Diagnostic Methods. Polish journal of radiology. 2015;80:368.
10. Altinkaya N, Demir S, Alkan O, Tan M. Diagnostic value of T2*-weighted gradient-echo MRI for segmental evaluation in cerebral venous sinus thrombosis. Clin Imaging. 2015;39(1):15-9.
11. Sadigh G, Mullins ME, Saindane AM. Diagnostic performance of MRI sequences for evaluation of dural venous sinus thrombosis. American Journal of Roentgenology. 2016;206(6):1298-306.
12. Selim M, Fink J, Linfante I, Kumar S, Schlaug G, Caplan LR. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol. 2002;59(6):1021-6.
13. Leach J, Strub W, Gaskill-Shipley M. Cerebral venous thrombus signal intensity and susceptibility effects on gradient recalled-echo MR imaging. American Journal of Neuroradiology. 2007;28(5):940-5.
14. Boukobza M, Crassard I, Bousser M, Chabriat H. MR imaging features of isolated cortical vein thrombosis: diagnosis and follow-up. American Journal of Neuroradiology. 2009;30(2):344-8.
15. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006;26(suppl_1):S19-S41.
16. Sari S, Verim S, Hamcan S, Battal B, Akgun V, Akgun H, et al. MRI diagnosis of dural sinus—Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences. Clin Neurol Neurosurg. 2015;134:44-54.
Files
IssueVol 58, No 8 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v58i8.4588
Keywords
Cerebral venous thrombosis T2 weighted imaging (T2WI) 3-Dimensional magnetic resonance venography (3DMRV)
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Jamalipour Soufi G, Hekmatnia A, Shafieyoun A, Afzali M. The Investigation of the Diagnostic Values of the T2WI Sequence in Cerebral Venous Sinuses Thrombosis in Comparison With 3D MRV. Acta Med Iran. 2020;58(8):383-387.