title: MDCT Venographic Patterns of Dural Venous Sinus Compromise After Acute Skull Fracture.
abstract: OBJECTIVE
  Prior studies have shown that skull fractures overlying the dural venous sinuses predispose the patient to an increased risk of dural venous sinus thrombosis (DVST). However, extrinsic compression may also cause sinus compromise and simulate thrombosis. This study set out to evaluate the prevalence and discernibility of DVST versus direct sinus compression in the setting of an overlying skull fracture.
  
  
  METHODS
  All initial head MDCT venography examinations performed at a level 1 trauma center over an 8-year period were reviewed (n = 347 patients). The examinations that showed an acute fracture overlying a dural sinus were included for review (n = 107 patients). Three neuroradiologists classified the MDCT venography findings as category 0 (normal), 1 (solely sinus compression), 2 (solely intraluminal thrombus), 3 (mixed sinus compression and DVST), or 4 (indeterminate). Clinical outcomes were assessed at 30-45 days after hospital discharge.
  
  
  RESULTS
  The percentage of patients in each category was as follows: category 0 (31-33% patients), 1 (38-46%), 2 (5-9%), 3 (8-11%), and 4 (8-13%). Categories 2-4 were more likely in the transverse sinus-sigmoid sinus complex (22-30%) and multiple dural sinuses (47-53%) than in the superior sagittal sinus (SSS) (5%). Interobserver reliability was strong (κ = 0.627-0.772; p < 0.0001). Sinus category was associated with fracture site (p = 0.014) but not with clinical outcome (p = 0.236).
  
  
  CONCLUSIONS
  Sinus compromise is common in patients with overlying skull fractures. Sinus compression can be distinguished from DVST on MDCT venography and is likely more prevalent than previously estimated. The fracture site may in part determine the pattern of compromise because fractures involving the transverse sinus-sigmoid sinus complex or multiple dural sinuses seem more likely to be affected by thrombosis than fractures involving the SSS.
authors.affiliation: 1 Department of Radiology, University of Minnesota Medical Center, MMC 292, 420 Delaware St SE, Minneapolis, MN 55455.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Rischall
authors.affiliation: 2 Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Boegel
authors.affiliation: 3 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Palmer
authors.affiliation: 3 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Barbara
authors.initials: B
authors.lastname: Knoll
authors.affiliation: 2 Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: McKinney
keywords: CT venography; dural venous sinus thrombosis; skull fracture