Computed Tomography Imaging Findings in the Patients with Cerebral Venous Thrombosis in Phra Nakhon Si Ayutthaya Hospital

Abstract

Background: Cerebral venous thrombosis (CVT) is a relatively uncommon but severe neurological disorder. Many factors, alone or combined, can cause cerebral venous sinus thrombosis. This condition is difficult to diagnose clinically because the patient can present with nonspecific symptoms. Consequently, imaging plays a primary role in diagnosis.

Objective: To determine the radiographic finding by computed tomography (CT) in CVT.

Methods: A retrospective review of 36 patients diagnosed with CVT who had CT performed (unenhanced CT, contrast-enhanced CT (CECT), and CT venography of the brain) in Phra Nakhon Si Ayutthaya between 1^st July 2017 to 1^st July 2021. Medical records were reviewed to analyze age, sex, sign and symptom, and underlying disease. The CT imaging was reviewed using Picture Archiving and Communications Systems (PACS) to analyze imaging findings by radiologists.

Results: Radiologic findings of CVT were cerebral edema (66.7%), intraparenchymal hemorrhage (58.3%), subarachnoid hemorrhage (25%), and intraventricular hemorrhage (8.3%). No parenchymal change was 25%. The sensitivity of unenhanced CT to identified dense triangle or cord sign (a direct sign of CVT) was 63.9%, and the sensitivity of contrast-enhanced CT (CECT) and CT venography of the brain to identified empty delta sign was 100%. Location of the thrombus was multiple locations (80.6%). The most common location of CVT was superior sagittal sinus, about 58.3%.

Conclusion: The most common radiologic finding of CVT was cerebral edema; the most common location of the thrombosis was superior sagittal sinus. A direct sign in unenhanced was found in only 63.9%. Further specified imaging (CT venography, MRI, and MRI venography) should be performed to increase the detection rate.