Evaluation of Cerebral Venous Thrombosis by CT, MRI and MR Venography.

OBJECTIVE: To study and compare cerebral parenchymal changes and sinuses involvement in CT with MRI and MRV in Cerebral Venous Thrombosis patients.

METHOD: This study was carried out in the Department of Radiodiagnosis, JLN Hospital and Research Center, Bhilai, Chhattisgarh from October 2012 to Nov 2014 and includes fifty patients of all age groups presenting with clinical symptoms of CVT, admitted in Neurology, Neurosurgery, Medicine, Pediatric, obstetric and Gynecology wards. CT, MRI and MRV findings were noted and statistical analysis was done using SPSS (Statistical package for Social science) 17.0 software. Categorical variables are expressed as frequencies and percentages. Sensitivity, Specificity, PPV and NPV of CT were calculated with respect to MRI in the diagnosis of cerebral venous thrombosis and associated brain parenchymal changes.

RESULT: Out of fifty cases of cerebral venous thrombosis, thirty-one were females and nineteen were males. Age range was newborn to seventy-one years with female predominance in young age. Majority of the patients presented with headache (78%) followed by seizures (32%). Out of the total 50 cases, superior sagittal sinus were involved in 24 cases, left transverse sinus in 22 cases, right transverse in 12 cases, left sigmoid in 20 cases, right sigmoid in 13 cases, left internal jugular vein in 12 cases, right internal jugular vein in 7cases, straight sinus in 5cases, superficial cortical veins in 6 cases, vein of Galen in 3 cases and internal cerebral veins in 2 cases. Cerebral parenchymal changes were associated with thrombosis in 26 patients, hemorrhagic infarct in 13 cases, only hemorrhage in 4 cases and only infarct in 5 cases. CT scan was able to diagnose sinus abnormality in 36% and parenchymal abnormality in 42% of cases as compare to 100% and 52% in MRI.

CONCLUSION: In the emergency setting CT scan plays an important role in evaluating patients clinically suspected CVT, whereas MRI combine with MR Venography is the best imaging technique for diagnosis of CVT in patients with equivocal findings on CT.