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Cerebral Venous Thrombosis and Multidetector CT Angiography: Tips and Tricks¹

¹ From the Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674 Paris cedex 14, France (M.H.R., M.C.J., V.M., M.Z.); the Department of Neuroradiology/MRI Unit, Centre Hospitalier Universitaire de Grenoble, Grenoble, France (A.K.); the Department of Radiology B, Hôpital Cochin, Paris, France (A.F.); and the Department of Radiology, Hôpital Beaujon, Clichy, France (A.H., J.M.C.). Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received February 2, 2006; revision requested March 8 and received April 6; accepted April 21. All authors have no financial relationships to disclose. Address correspondence to M.H.R. (e-mail: mathieurodallec{at}hotmail.com).

Because of the great diversity of clinical features, its unforeseeable evolution, and a small proportion of cases that will worsen in the acute phase, cerebral venous thrombosis must be diagnosed as early as possible so that specific treatment can be started, typically transcatheter thrombolysis or systemic anticoagulation. Unenhanced computed tomography (CT) is usually the first imaging study performed on an emergency basis. Unenhanced CT allows detection of ischemic changes related to venous insufficiency and sometimes demonstrates a hyperattenuating thrombosed dural sinus or vein. Helical multidetector CT venography with bolus power injection of contrast material and combined use of two-dimensional and three-dimensional reformations (maximum intensity projection, integral display, and volume rendering) provides exquisite anatomic detail of the deep and superficial intracranial venous system and can demonstrate filling defects. However, common variants of the sinovenous system should not be mistaken for sinus thrombosis. A comprehensive diagnostic approach facilitates imaging of cerebral venous thrombosis with multidetector CT.

© RSNA, 2006

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