Linn J, Pfefferkorn T, Ivanicova K, Müller-Schunk S, Hartz S, Wiesmann M, Dichgans M, Brückmann H
Department of Neuroradiology, University Hospital Munich, Munich, Germany.
AJNR Am J Neuroradiol. 2009 Apr;30(4):728-35. doi: 10.3174/ajnr.A1451. Epub 2009 Feb 12.
With its highly variable clinical presentation, the diagnosis of cerebral venous sinus thrombosis (SVT), and especially of deep venous thrombosis (DVT), as rare but important causes of stroke is challenging. Because noncontrast cranial CT (NCCT) is still the imaging technique of choice in most emergency departments, we aimed to investigate its value in the diagnosis of SVT and DVT.
Screening our patient data base, we identified 8 patients with DVT and 25 patients with SVT. We also included a control group of 36 patients who had presented with clinical signs of DVT or SVT but in whom thrombosis was subsequently excluded. MR imaging, multidetector row CT angiography (MDCTA), and/or digital subtraction angiography (DSA) were used as the reference standard. Three independent readers assessed the NCCTs for the presence of direct and indirect signs of DVT or SVT. Direct signs included the presence of hyperattenuated sinuses (ie, cord sign) or veins (ie, attenuated vein sign), whereas parenchymal edema and hemorrhage were indirect signs.
The sensitivity and specificity of the attenuated vein sign for the diagnosis of DVT were 100%, and 99.4%, respectively, whereas the sensitivity and specificity of the cord sign for SVT were 64.6% and 97.2%, respectively. The sensitivity and specificity values of NCCT were 93.7% and 98% for intracerebral edema and 94.8% and 98.7% for intracerebral hemorrhages, respectively.
Although NCCT is insufficient to exclude a SVT, its value in the emergency diagnosis of DVT seems to be very high.
脑静脉窦血栓形成（SVT），尤其是深部静脉血栓形成（DVT），作为罕见但重要的卒中病因，其临床表现高度多变，诊断具有挑战性。由于非增强头颅CT（NCCT）仍是大多数急诊科首选的成像技术，我们旨在研究其在SVT和DVT诊断中的价值。
通过筛查我们的患者数据库，我们确定了8例DVT患者和25例SVT患者。我们还纳入了一个由36例患者组成的对照组，这些患者有DVT或SVT的临床症状，但随后排除了血栓形成。磁共振成像、多排螺旋CT血管造影（MDCTA）和/或数字减影血管造影（DSA）被用作参考标准。三位独立的阅片者评估NCCT上是否存在DVT或SVT的直接和间接征象。直接征象包括高密度的静脉窦（即条索征）或静脉（即低密度静脉征），而脑实质水肿和出血为间接征象。
低密度静脉征诊断DVT的敏感性和特异性分别为100%和99.4%，而条索征诊断SVT的敏感性和特异性分别为64.6%和97.2%。NCCT对脑水肿的敏感性和特异性值分别为93.7%和98%，对脑出血的敏感性和特异性值分别为94.8%和98.7%。
虽然NCCT不足以排除SVT，但其在DVT急诊诊断中的价值似乎非常高。
