Non-contrast CT image characteristics on admission predict the 3-month outcome of cerebral venous sinus thrombosis: An observational study in a single institution

Abstract

Background: Various computed tomography (CT) appearances of cerebral venous sinus thrombosis (CVST) were associated with different prognosis and the patients with large intracranial hematoma will have adverse outcomes, but no in-depth study of non-contrast CT image appearances was carried out. We aimed to test the hypothesis that non-contrast CT image characteristics on admission are associated with and predict the outcome of CVST at 3 months. Methods: Three hundred and six patients with CVST between 2008 and 2017 were collected. Age, sex, onset of CVST(acute, subacute, or chronic), etiology, clinical manifestations, midline shift, occluded venous sinus, location of infarction, non-contrast CT image characteristics, and the 3-month outcome were recorded. In addition, we established a non-contrast CT image-based classification and grading system to test the hypothesis; the CVST patients were classified into four grades (namely non-contrast CT image-based classification): grade I, no obvious abnormality; grade II, simple vein infarction without hemorrhage or with subarachnoid hemorrhage; grade III, cerebral venous infarction with subarachnoid hemorrhage; and grade IV, cerebral vein infarction with hematoma. All enrolled patients had received subcutaneous injections of low molecular weight heparin subcutaneous injection for 14 days. Thereafter, oral anticoagulant therapy with warfarin was continued. Patients with epilepsy were given antiepileptic drugs, and patients with cerebral herniation received decompressive craniotomy. Results: Our observational findings revealed that midline shift (> 5 mm), location of lesion (frontal lobe and temporal lobe), and cerebral venous infarction with subarachnoid or hematoma (grade III and IV) were associated with 3-month poor outcome (p < 0.05); the respective increased risks were 12.730 [risk ratio (RR) 12.730, 95% confidence interval (CI) 1.680-96.490, p = 0.014], 46.538 (RR 146.538, 95% CI 6.222-348.079, p = 0.000), 32.549 (RR 32.549, 95% CI 2.180-486.104, p = 0.012), 37.725 (RR 37.725, 95% CI 2.051-693.778, p = 0.015), and 93.164-fold (RR 93.164, 95% CI 11.137-779.328, p = 0.000). However, seizure, hemiplegia, location of occluded venous sinus (super sagittal sinus and deep venous systems), location of infarction (parietal lobe), and non-contrast CT image-based classification (I) were not correlated with the adverse outcome (p > 0.05). Conclusions: Our findings suggested that non-contrast CT image characteristics on admission were associated with and predict the 3-month outcome of CVST. However, the ultimate conclusions need to be confirmed by a large sample of CVST patients at multiple institutions.