Imaging of cerebral venous and sinus thrombosis

Abstract

Cerebral venous and sinus thrombosis (CVST) constitutes a rare but important cause of stroke with an annual incidence of approximately three to four cases per one million adults. In recent decades, the clinical outcome of CVST has significantly improved, largely due to improved neuroimaging methods. However, the average interval from symptom onset to definite diagnosis is still 7 days. This is mainly due to its subacute onset and its unspecific clinical presentation. To avoid delayed diagnosis, it is essential to consider CVST as a differential diagnosis in patients presenting with unspecific neurological symptoms, particularly headache, other signs of elevated intracranial pressure, and seizures. Magnetic resonance imaging (MRI) and computed tomography (CT) with CT angiography provide excellent techniques for the diagnosis of sinus or deep cerebral venous thrombosis. The diagnosis of cortical venous thrombosis is particularly challenging and requires T2*WI MRI sequences. Knowledge of potential diagnostic pitfalls and artifacts is essential to avoid misinterpretation of MRI or CT.