Cerebral venous thrombosis: diagnostic accuracy of combined, dynamic and static, contrast-enhanced 4D MR venography.
OBJECTIVE
MR including MRV is an established method to diagnose CVT. However, it remains unsettled which MR imaging modalities offer the highest diagnostic accuracy. We evaluated the accuracy of a combined, dynamic (1.5 seconds per dataset) and static (voxel size, 1.1 x 0.9 x 1.5 mm), contrast-enhanced MRV method (combo-4D MRV) relative to other established MR/MRV modalities.


METHODS
A total of 39 patients with CVT (n = 20) and control subjects (n = 19) underwent combo-4D MRV, 2D TOF MRV, GRE imaging, and T2W imaging. For these modalities, diagnostic accuracy (ROCs) for CVT affecting 53 out of 234 predefined venous segments was determined. Sensitivity and specificity were separately calculated for different stages of CVT (acute/subacute/chronic).


RESULTS
Combo-4D MRV showed the highest accuracy (AUC, 0.99 [95% CI, 0.97-1.0]; sensitivity, 97% [84%-100%]) for thrombosed dural sinuses. For all thrombosed segments including cortical veins, its sensitivity was best (76% [64%-84%]; AUC, 0.92 [0.88-0.96]), followed by TOF MRV (72% [59%-81%]; AUC, 0.93 [0.88-0.97]). Even for chronic CVT, it showed a relatively high sensitivity of 67% (30%-90%). For thrombosed cortical veins alone, GRE images achieved the highest sensitivity (66% [46%-81%]; AUC, 0.88 [0.78-0.97]). Specificities of all modalities ranged from 96% to 99%.


CONCLUSIONS
Combo-4D MRV showed an excellent accuracy for the diagnosis of dural sinus thrombosis. The analysis of dynamic patterns of contrast enhancement in dural sinuses appeared useful to identify chronic thrombosis. To diagnose thrombosed cortical veins, GRE images should primarily be analyzed.
Meckel
S
S
Division of Neuroradiology, Institute of Radiology, University of Basel Hospital, Basel, Switzerland. stephanmeckel@gmail.com
Reisinger
C
C
Bremerich
J
J
Damm
D
D
Wolbers
M
M
Engelter
S
S
Scheffler
K
K
Wetzel
S G
SG
D000328:Adult; D000368:Aged; D002550:Cerebral Veins / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000627:therapeutic use; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods* / Q000592:standards*; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods* / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*; D055815:Young Adult
D003287:Contrast Media