Abstract
BackgroundClinical 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.MethodsA 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).ResultsLess 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%).ConclusionsDespite 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.
Highlights
Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache
Despite previous reports suggesting the applicability of nonenhanced CT (neCT) to accurately identify acute Cerebral venous sinus thrombosis (CVST), other methods such as magnetic resonance imaging (MRI) or computed tomography (CT) venography (CTV) are recommended to verify the diagnosis of CVST
All patients in the main study cohort had been referred for a neuroradiological examination, been examined with both a neCT and CTV, had a medical history of nontraumatic headache, and a clinical suspicion from the referring physician of CVST written in the radiological referral
Summary
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. Correct clinical suspicion of CVST is complicated by the fact that the condition frequently causes symptoms seen in more common diagnoses, such as stroke or brain tumors. Isolated headache is a common but unspecific symptom for patients seen in emergency departments and only a fraction of these patients have CVST. Previous studies have reported on the diagnostic utility of nonenhanced head computed tomography (neCT) to suspect CVST due to high density in the sinuses [11, 12, 19–22]. Considered the gold standard, digital subtraction angiography is not a common diagnostic tool for CVST
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