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AJNR - American Journal of Neuroradiology

Publication Preview: Published November 5, 2009

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1869

BRAIN

Cerebral Venous Thrombosis: Diagnostic Accuracy of Combined, Dynamic and Static, Contrast-Enhanced 4D MR Venography

S. Meckel, C. Reisinger, J. Bremerich, D. Damm, M. Wolbers, S. Engelter, K. Scheffler and S.G. Wetzel

From the Divisions of Neuroradiology (S.M., D.D., S.G.W.) and Diagnostic Radiology (C.R., J.B.), Institute of Radiology, University of Basel Hospital, Basel, Switzerland; Clinical Trial Unit (M.W.), University of Basel Hospital, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics (M.W.), University of Basel Hospital, Basel, Switzerland; Department of Neurology (S.E.), University of Basel Hospital, Basel, Switzerland; and Division of Radiological Physics (K.S.), Institute of Radiology, University of Basel Hospital, Basel, Switzerland.

Please address correspondence to Stephan Meckel, MD, Division of Neuroradiology, Institute of Radiology, University of Basel Hospital, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: stephanmeckel{at}gmail.com

BACKGROUND AND PURPOSE: 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.

MATERIALS AND 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.

Abbreviations: TSE, turbo spin-echo