Role of Magnetic Resonance Venography in the Evaluation of Cerebral Veins and Sinuses Occlusion

TL;DR

The study compares the effectiveness of magnetic resonance venography and MRI in diagnosing cerebral venous thrombosis and highlights the importance of advanced imaging techniques for accurate diagnosis.

Contribution

The study provides new insights into the comparative diagnostic efficacy of MRV and MRI sequences in detecting cerebral venous thrombosis.

Findings

MRV detected thrombosis in deep venous segments more frequently than T1w/FLAIR, with a statistically significant difference.

Distinguishing between cytotoxic and vasogenic edema using DWI is critical for prognosis in cerebral venous thrombosis.

Subarachnoid hemorrhage may serve as a valuable diagnostic clue for CVT when basal cisterns are unaffected.

Abstract

Objective

This study aims to evaluate the diagnostic efficacy of various imaging techniques in identifying cerebral venous thrombosis (CVT) and to investigate the clinical features associated with this condition.

Methodology

This prospective study, conducted from September 2022 to June 2024 at Shri B.M. Patil Medical College, included 55 patients clinically suspected of having CVT. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were used for diagnosis, employing sequences such as axial T1-weighted spin echo (T1 SE), sagittal T1 fluid-attenuated inversion recovery (T1 FLAIR), axial and coronal T2 fast spin echo (T2 FSE), axial T2 star-weighted gradient echo (T2*), and two-dimensional time-of-flight (2D TOF) imaging. Diffusion-weighted imaging (DWI) was utilized to distinguish between cytotoxic edema, indicating cellular injury typically resulting from infarction, and vasogenic edema, which reflects fluid leakage due to blood-brain barrier disruption. The study assessed the clinical features and imaging findings and compared the diagnostic efficacy of MRV to that of conventional MRI. The presence of subarachnoid hemorrhage (SAH) as an indicator of CVT was also evaluated. Chi-square tests were used to determine statistical significance, with a p-value of <0.05 considered significant.

Results

Of the 55 patients, 36 (65.5%) were men and 19 (34.5%) were women. There was no significant difference between MRV and T1w/FLAIR in detecting thrombosis of the superior sagittal sinus (34 (61.8%)), left transverse sinus (17 (30.9%) vs. 13 (23.6%), p=0.3918), right transverse sinus (26 (47.3%) vs. 26 (47.3%)), right sigmoid sinus (6 (10.9%) vs. 6 (10.9%)), and left sigmoid sinus (20 (36.4%) vs. 20 (36.4%)). CVT was identified more frequently by MRV (9 (16.3%)) than by T1w/FLAIR (3 (5.4%)), with a p-value approaching significance (p=0.0565). Thrombosis in deep venous segments was detected more often by MRV (12 (21.8%)) compared to T1w/FLAIR (two (3.6%)), with a statistically significant difference (p=0.0104).

Conclusion

The study underscores the importance of advanced imaging techniques, including MRV and DWI, in accurately diagnosing CVT. Distinguishing between cytotoxic and vasogenic edema is critical for prognosis. SAH may be a valuable diagnostic clue for CVT, especially when the basal cisterns are unaffected. Despite its limitations, T2* imaging aids in detecting specific aspects of CVT. These findings highlight the need for comprehensive imaging strategies to enhance diagnostic accuracy and improve patient management. However, limitations such as the relatively small sample size and single-center design may affect the generalizability of the results. Larger multicenter studies are warranted to validate these observations.