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Background: Cerebral venous thrombosis (CVT) has diverse clinical presentations that are often nonspecific. Early diagnosis is crucial because early intervention, including anticoagulation and systemic or catheter-directed thrombolysis, is associated with favorable clinical outcomes. Magnetic resonance imaging (MRI) and MR venography (MRV) have become preferred techniques because of noninvasiveness with high image resolution.
Objectives: To compare the diagnostic accuracy of contrast-enhanced 3D T1-weighted high-resolution isotropic volume excitation (THRIVE) MRI sequences versus contrast-enhanced MRV for the detection of dural venous sinus (DVS) thrombosis.
Methods: Contrast-enhanced 3D THRIVE and contrast-enhanced MRV sequences of 98 patients, acquired between August 2010 and November 2012, were retrospectively reviewed by neuroradiologists for detection of DVS thrombosis in each of eight venous sinus segments (total, 784 venous segments). Diagnostic performance values were calculated for contrast-enhanced 3D THRIVE MRI sequences.
Results: Eleven patients (30 venous segments) had definite DVS thrombosis on contrast-enhanced MRV, according to neuroradiologists. Compared with contrast-enhanced MRV, the 3D THRIVE had a per-patient sensitivity and specificity of 81.8% and 92%, respectively, and a per-segment sensitivity and specificity of 90% and 98.4%, respectively. The positive predictive value of 3D THRIVE in detecting DVS thrombosis was 56.3% per patient and 69.2% per venous segment; the negative predictive value was 97.6% per patient and 99.6% per venous segment.
Conclusions: Contrast-enhanced 3D spoiled gradient-echo high-resolution T1-weighted MRI sequences (contrast-enhanced 3D THRIVE at our institution) have high diagnostic accuracy in detecting DVS thrombosis and are reliable for excluding DVS thrombosis in clinically suspected patients.
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2. Wasay M, Kojan S, Dai AI, Bobustuc G, Sheikh Z. Headache in Cerebral Venous Thrombosis: incidence, pattern and location in 200 consecutive patients. J Headache Pain. 2010;11(2):137-139. doi:10.1007/s10194-010-0186-3.
3. Garetier M, Rousset J, Pearson E, et al. Value of spontaneous hyperdensity of cerebral venous thrombosis on helical CT. Acta Radiol. 2014;55(10):1245-1252. doi:10.1177/0284185113513977.
4. Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012;43(12):3375-3377. doi:10.1161/STROKEAHA.112.671453.
5. Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Stroke. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158-1192. doi:10.1161/STR.0b013e31820a8364.
6. Saindane AM, Mitchell BC, Kang J, Desai NK, Dehkharghani S. Performance of spin-echo and gradient-echo T1-weighted sequences for evaluation of dural venous sinus thrombosis and stenosis. AJR Am J Roentgenol. 2013;201(1):162-169. doi:10.2214/AJR.12.9095.
7. Karthikeyan D, Vijay S, Kumar T, Kanth L. Cerebral venous thrombosis-spectrum of CT findings. Indian J Radiol Imaging. 2004;14:129-137.
8. Sari S, Verim S, Hamcan S, 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. doi:10.1016/j.clineuro.2015.04.013.
9. 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.
10. Provenzale JM, Kranz PG. Dural sinus thrombosis: sources of error in image interpretation. AJR Am J Roentgenol. 2011;196(1):23-31. doi:10.2214/AJR.10.5323.
11. Leach JL, Wolujewicz M, Strub WM. Partially recanalized chronic dural sinus thrombosis: findings on MR imaging, time-of-flight MR venography, and contrast-enhanced MR venography. AJNR Am J Neuroradiol. 2007;28(4):782-789.
12. Liang L, Korogi Y, Sugahara T, et al. Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence: prospective comparison with 2D-TOF MR venography and digital subtraction angiography. AJNR Am J Neuroradiol. 2001;22(3):481-492.
13. Fleiss JL, Levin B, Paik MC. The Measurement of Interrater Agreement. In: Shewhart WA, Wilks SS, eds. Statistical Methods for Rates and Proportions. Hoboken, NJ: John Wiley & Sons; 2004:598-626.
14. Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174.