Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis.
BACKGROUND
The aim of the study was to investigate the sensitivity and specificity of non-contrast computed tomography (NCCT) in the diagnosis of cerebral venous sinus thrombosis (CVST). Methods. Screening our neurological department database, we identified 53 patients who were admitted to neurological emergency department with clinical signs of CVST. Two independent observers assessed the NCCT scans for the presence of CVST. CT venography and/or MR venography were used as a reference standard. Interobserver agreement between the two readers was assessed using Kappa statistic. Attenuation inside the cerebral venous sinuses was measured and compared between the patient and the control group.


RESULTS
CVST was confirmed in 13 patients. Sensitivity and specificity of NCCT for overall presence of CVST were 100% and 83%, respectively, with Kappa value of 0.72 (a good agreement between observers). The attenuation values between CVST patients and control group were significantly different (73.4 ± 14.12 HU vs. 58.1 ± 7.58 HU; p = 0.000). The ROC analysis showed an area under the curve (AUC) of 0.916 (95% CI, 0.827 - 1.00) and an optimal cutoff value of 64 HU, leading to a sensitivity of 85% and specificity of 87%.


CONCLUSIONS
NCCT as a first-line investigation has a high value for diagnosis of CVST in the emergency setting. The additional measurement of the sinus attenuation may improve the diagnostic value of the examination.
Clinical Institute of Radiology, University Medical Centre, Ljubljana, Slovenia.
Jernej
J
Avsenik
Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
Janja Pretnar
JP
Oblak
Clinical Institute of Radiology, University Medical Centre, Ljubljana, Slovenia.
Katarina Surlan
KS
Popovic
cerebral venous sinus thrombosis; computed tomography; stroke
Front Neurol Neurosci. 2008;23:23-54
18004052
Radiographics. 1999 Jul-Aug;19(4):1098-101
10464815
Lancet Neurol. 2007 Feb;6(2):162-70
17239803
AJNR Am J Neuroradiol. 1999 Feb;20(2):249-55
10094346
Circulation. 2012 Apr 3;125(13):1704-9
22474313
J Neuroradiol. 1994 Apr;21(2):81-99
8014661
Stroke. 2004 Dec;35(12):2820-5
15514174
Fam Med. 2005 May;37(5):360-3
15883903
Stroke. 2004 Mar;35(3):664-70
14976332
Eur Radiol. 2004 Feb;14(2):215-26
14530999
AJNR Am J Neuroradiol. 2009 Apr;30(4):728-35
19213820
AJNR Am J Neuroradiol. 2002 Sep;23(8):1402-3
12223385
Stroke. 2005 Aug;36(8):1716-9
16020765
J R Soc Med. 2000 May;93(5):234-7
10884765
AJNR Am J Neuroradiol. 2013 Aug;34(8):1568-72
23471024
AJR Am J Roentgenol. 1997 Dec;169(6):1699-707
9393193
Radiology. 1987 Mar;162(3):779-85
3809494
Radiographics. 2006 Oct;26 Suppl 1:S19-41; discussion S42-3
17050515
Emerg Radiol. 2008 Sep;15(5):325-33
18437434
Stroke. 2009 Feb;40(2):476-81
19118248
J Comput Assist Tomogr. 2012 Jan-Feb;36(1):8-13
22261764
Stroke. 2011 Apr;42(4):1158-92
21293023
AJNR Am J Neuroradiol. 2011 Aug;32(7):1354-7
21566009
Clin Radiol. 1997 Sep;52(9):672-9
9313731
N Engl J Med. 2005 Apr 28;352(17 ):1791-8
15858188
Eur J Neurol. 2004 Jun;11(6):405-9
15171737