title: Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis.
abstract: BACKGROUND
  The only direct sign of sinus thrombosis on non-contrast computerized tomography (NCCT) is the hyperdense sign. The purpose of our study was to assess quantitative parameters for diagnosis of superficial venous sinus thrombosis and to compare these quantitative criteria with the current standard of qualitative evaluation.
  
  
  METHODS
  This retrospective case-control study included 18 patients with acute superficial sinus thrombosis and 18 matched controls. Three blinded readers independently evaluated the NCCT for the presence of hyperdense sign using axial slices only followed by axial slices with multiplanar reformats. Absolute attenuation values and ratios were calculated for thrombosed and non-thrombosed sinuses: Ratiotarget sinus/lowest attenuation sinus, Ratiotarget sinus/basilar artery, Ratiotarget sinus/internal carotid artery, Ratiotarget sinus/temporal lobe, and Ratiotarget sinus/frontal lobe.
  
  
  RESULTS
  There was a significant difference in absolute attenuation values and ratios between thrombosed and non-thrombosed sinuses, with the absolute attenuation and the Ratiotarget sinus/lowest attenuation sinus being the most differentiating. The mean attenuation for thrombosed sinuses was 69 Hounsfield units (HU) (95 % CI 65-72 HU) vs. 52 HU (95 % CI 51-54) for non-thrombosed, P < 0.0001. The mean Ratiotarget/lowest attenuation was 1.5 (95 % CI 1.4-1.6) for thrombosed sinuses vs. 1.1 (95 % CI 1.0-1.1) for non-thrombosed, P < 0.0001. Optimal thresholds of 62 HU and 1.3 yielded sensitivities of 81 and 84 %, respectively. Hyperdense sign had a sensitivity of 63 % on axial images and 67 % with the addition of multiplanar reformats.
  
  
  CONCLUSIONS
  Density measurements result in substantial improvement over visual inspection in the diagnosis of superficial venous sinus thrombosis on NCCT.
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Sohail
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9. diancu@toh.on.ca.
authors.forename: Daniela
authors.initials: D
authors.lastname: Iancu
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Seppala
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Satya
authors.initials: S
authors.lastname: Patro
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Rafael
authors.initials: R
authors.lastname: Glikstein
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Thornhill
authors.affiliation: Department of Diagnostic Medical Imaging, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Room C159, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Cheemun
authors.initials: C
authors.lastname: Lum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media; D004388:Dura Mater / Q000098:blood supply / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010690:Phlebography / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: CT; Cerebral venous sinus thrombosis; Diagnosis; Quantitative measurement