Cortical vein thrombosis: the diagnostic value of different imaging modalities.
BACKGROUND
Cortical vein thrombosis (CVT) is a rare disorder, and its diagnosis is challenging. The aim of our study was to evaluate the value of different imaging modalities for the detection of CVT.


METHODS
Thirteen patients with CVT, either isolated (n = 3) or in combination with sinus thrombosis (n = 10), and 20 control patients without any venous pathologies were included in this study. The analysis was performed independently by three blinded readers who evaluated the following imaging modalities and sequences separately: non-enhanced computed tomography (NCCT); multi-detector row CT angiography (MDCTA); diffusion-weighted (DWI), T1-weighted (T1w), PD-weighted (PDw), T2*-weighted (T2*w), and fluid-attenuated inversion recovery-weighted (FLAIRw) magnetic resonance (MR) sequences; as well as venous MR angiography (vMRA). The sensitivity, specificity, positive (PPV) and negative predictive values, and interobserver agreement of the different modalities were calculated.


RESULTS
T2*w showed the highest sensitivity for the detection of CVT (97.4%), followed by T1w (70%). FLAIRw and vMRA had a sensitivity of 50% and 41.7%, respectively, whereas the sensitivity of NCCT, MDCTA, DWI, and PDw was below 30%. The specificity and PPV of all modalities was 100%, with good to perfect interobserver agreement.


CONCLUSIONS
T2*w was the superior MR imaging sequence for diagnosing CVT. Besides T2*w, only T1w reached a sensitivity of over 50% for CVT, followed by FLAIRw, and vMRA. On the contrary, our results suggest that NCCT but also MDCTA might not be suitable for diagnosing CVT.
Linn
Jennifer
J
Department of Neuroradiology, University Hospital Munich, Marchioninistr. 15, 81377, Munich, Germany. linn@nrad.de
Michl
Stefan
S
Katja
Bochmann
B
Pfefferkorn
Thomas
T
Wiesmann
Martin
M
Hartz
Sabine
S
Dichgans
Martin
M
Brückmann
Hartmut
H
D000328:Adult; D002533:Cerebral Angiography / Q000379:methods*; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020246:Venous Thrombosis / Q000175:diagnosis*; D055815:Young Adult