A COMPARATIVE STUDY OF CT VENOGRAPHY WITH MR VENOGRAPHY IN CEREBRO SINOVENOUS THROMBOSIS

Abstract

BACKGROUND:

Cerebral venous thrombosis is an uncommon condition. Its presentation is varied and often dramatic. It often affects young to middle aged patients, and more commonly women. Although recognized for more than 100 years, it has only in recent years, come of importance. This is partly due to improved non-invasive imaging techniques for diagnosing cerebral venous thrombosis.

CSVT can lead to devastating disability and even death, if not timely diagnosed and treated¹.It is associated with a wide spectrum of etiologic factors, clinical presentation is often nonspecific, and the diagnostic imaging features can be subtle.²

MATERIALS AND METHODS:

A prospective study of 40 patients was done in the Department of Radiology, MGM Hospital Warangal-Telangana from December 2020 to June 2022.

The plain CT with CT venography was carried out on GE lightspeed 16 slice CT machine and plain MR with MR venography was carried out on 1.5 Tesla GE MR machine in our department. 40 patients were referred to the Department of Radiodiagnosis with clinical suspicion of cerebral venous thrombosis and plain CT showing suspicious signs of CSVT.

RESULTS:

In our study 31-40 years was the common age group involved with 43% patients falling into this bracket. Sensitivity of plain CT in diagnosing CSVT-60% Specificity of plain CT in diagnosing CSVT-87%. Percentage of hemorrhagic lesion detected on T1W/T2/FLAIR- 91% Percentage of hemorrhagic lesion detected on GRE- 100%. Percentage of hemorrhagic lesion detected on T1W/T2/FLAIR- 91% Percentage of hemorrhagic lesion detected on GRE- 100%. The most common sinus involved- SSS (37.5%) Incidence of superficial venous thrombosis-81% Incidence of deep veins thrombosis- 20% Incidence of cortical venous thrombosis- 7.5%.

CONCLUSION:

CSVT was common in 31-40 years old age group and male sex in our study. Dehydration followed by alcohol abuse and post-partum status were the most common risk factors. Sensitivity and specificity of plain CT was 60% and 87% respectively with diagnosing features being hyperdense sinus/cord sign, hemorrhagic infarct and non-hemorrhagic infarct. Parenchymal changes in cerebral venous thrombosis were better evaluated on MRI. Venous abnormalities were better depicted in MRI as loss of flow voids in T1, T2 and with dark signal on GRE. Hemorrhagic bleeds were easily evaluated on MRI with 100% sensitivity with GRE sequence; few showed only hypodensity on CT probably related to chronicity of bleed. CT Venography was easier to interpret, showed better and faster depiction of sinuses, with thin section reformatted images, when imaged with a delay of 45 seconds. CT venography showed higher spatial resolution compared to MR venography. Hypoplastic sinuses were easily visualized on CT Venography with smaller ipsilateral jugular foramen on bone window. Thorough evaluation of all pulse sequences is important, to detect slow flow, arachnoid granulation and loss of flow voids in thrombus. We conclude that CT venography is superior to MR venography in identifying cerebral veins and in diagnosing dural sinus thrombosis.