Plain CT vs MR venography in acute cerebral venous sinus thrombosis: Triumphant dark horse

Context: Most patients with cerebral venous sinus thrombosis (CVST) present with nonspecific signs and symptoms and are likely to undergo nonenhanced head computed tomography (NCT) at presentation, which may show a normal report in up to two-thirds of patients. However, in case of acute thrombosis, sensitivity of diagnosing CVST is high as sinuses are hyperdense. Though magnetic resonance imaging (MRI) is considered the imaging modality of choice for diagnosing CVST, it is not universally available in an acute setting. Aims: To evaluate whether increased attenuation in cerebral venous sinuses in acute condition can be used to diagnose acute CVST and to determine its diagnostic value. Materials and Methods: The study involves two independent groups. One group of patients with sinus thrombosis were confirmed by MR venography (group A). The other group included patients without sinus thrombosis (group B). The HU (CT attenuation), hemoglobin (HGB), hematocrit (HCT), and H: H (HU: HCT) ratio of both groups were compared. Thirty-six patients (59 thrombotic sinuses) were studied in group A and 40 in group B. Statistical Analysis: Average HU and H: H ratio were compared using two-tailed t-test, and linear regression analysis was used to assess correlation between HCT and HU. Results: Average HU (73.7 vs 48.6) and H: H ratio values were higher in group A patients compared to group B (P < 0.05). Linear regression analysis showed positive correlation between HGB and HCT with HU among both the groups (P < 0.05). Conclusions: Our study demonstrates that acute CVST can be diagnosed using HU values in NCT.