Department of Clinical Neuroscience, Karolinska Institutet, 17176, Stockholm, Solna, Sweden.
Department of Neuroradiology, Karolinska University Hospital, 17176, Stockholm, Solna, Sweden.
BMC Med Imaging. 2020 Feb 27;20(1):24. doi: 10.1186/s12880-020-00426-x.
Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT) in patients with nontraumatic headache and clinically suspected CVST.
A retrospective consecutive series of patients referred 2013-2015 for radiology were evaluated. Eligible patients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography (CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All CTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT (2017-2019).
Less than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining 99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the patient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of CVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65) venous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion written in referral, 10%).
Despite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon. Evaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems reasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading neCT for other indications.
由于头痛等非特异性症状，临床怀疑脑静脉窦血栓形成（CVST）并不准确。目的是回顾性评估非增强 CT（neCT）在非创伤性头痛和临床怀疑 CVST 的患者中的诊断价值。
评估了 2013 年至 2015 年因放射学检查而转诊的连续回顾性病例系列。符合条件的患者有非创伤性头痛和转诊中提到的 CVST 怀疑，通过 CT 静脉造影（CTV）和非增强 CT（neCT）进行检查。对 neCT 扫描是否存在 CVST 或其他病理学进行重新评估。所有 CTV 均检查是否存在 CVST。验证队列由 10 例非创伤性 CVT 患者（2017-2019 年）组成。
不到 1%（1/104）的患者在 neCT 上有可疑血栓，随后 CTV 证实。其余 99%的患者 CTV 排除 CVST。11%的患者有其他影像学发现可以解释他们的症状。在 CVST 患者中，血栓形成的硬脑膜窦呈高衰减（最大 HU 89），导致 CTV 怀疑并证实了 CVST。验证队列（n=10）证实，在所有 10 天内就诊的患者（转诊中怀疑为 10%）中，所有存在确诊血栓的患者均存在高衰减（HU＞65）静脉结构。
尽管有临床怀疑，但在非创伤性头痛中 CVST 的影像学表现并不常见。评估 neCT 硬脑膜窦高衰减，然后在有选择的情况下进行 CTV 以确认似乎是合理的。所有放射科医生都应认识到 CVST，并且在阅读 neCT 进行其他检查时需要高度警惕。
