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Comparison of CT Venography with MR Venography in Cerebral Sinovenous Thrombosis

N. Khandelwal1, Ajay Agarwal1,2, Rohit Kochhar1, J. R. Bapuraj1, Paramjeet Singh1, S. Prabhakar3 and S. Suri1

1 Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
2 Present address: Kesri Bhavan, 2/1/1B Munshi Bazar Rd., Kolkata 700015, India.
3 Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.


Figure 1
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  		Fig. 1 —18-year-old woman with sudden onset of headache and seizures. Unenhanced CT of head in axial plane shows cord sign in straight sinus (arrow) and "dense vein" sign in superior sagittal sinus (arrowhead). No parenchymal changes are present. Both CT venography and MR venography confirmed presence of venous sinus thrombosis.

 

Figure 2
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  		Fig. 2A —45-year-old woman with headache and altered sensorium. Unenhanced CT scan of head in axial plane shows hemorrhagic infarcts in bilateral parietooccipital lobes.

 

Figure 3
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  		Fig. 2B —45-year-old woman with headache and altered sensorium. T1-weighted MR image in sagittal plane shows hyperintense signal in superior sagittal sinus and loss of normal flow void (arrows).

 

Figure 4
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  		Fig. 3A —20-year-old man with headache. Axial T2-weighted (A) and coronal FLAIR (B) MR images show no parenchymal abnormalities and normal flow voids in superior sagittal sinus (arrows, A) and both lateral sinuses (arrows, B).

 

Figure 5
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  		Fig. 3B —20-year-old man with headache. Axial T2-weighted (A) and coronal FLAIR (B) MR images show no parenchymal abnormalities and normal flow voids in superior sagittal sinus (arrows, A) and both lateral sinuses (arrows, B).

 

Figure 6
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  		Fig. 3C —20-year-old man with headache. Sagittal maximum-intensity-projection MR venogram shows loss of flow signal in superior sagittal sinus (arrow).

 

Figure 7
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  		Fig. 3D —20-year-old man with headache. Three-dimensional CT venogram using integral algorithm depicts superior sagittal sinus thrombosis as intraluminal filling defect (arrow) that extends into right transverse sinus.

 

Figure 8
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  		Fig. 4A —30-year-old man with severe headache. CT venography axial source image shows complete thrombosis of left transverse sinus and partial thrombosis of right transverse sinus. Arrows indicate filling defect.

 

Figure 9
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  		Fig. 4B —30-year-old man with severe headache. CT venography axial source image shows complete thrombosis of left sigmoid sinus and partial thrombosis of right sigmoid sinus. Arrows indicate filling defect.

 

Figure 10
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  		Fig. 4C —30-year-old man with severe headache. Two-dimensional fast low-angle shot MR venogram in axial plane shows isointense signal in left sigmoid sinus and normal flow signal on right side.

 

Figure 11
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  		Fig. 4D —30-year-old man with severe headache. FLAIR MR image in coronal plane shows hyperintense signal in superior sagittal sinus and left sigmoid sinus and normal flow void in right sigmoid sinus (arrow). MR venography missed partial thrombosis of right transverse and sigmoid sinuses.

 

Figure 12
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  		Fig. 5A —28-year-old postpartum woman with sudden loss of consciousness. Sagittal maximum-intensity-projection image of CT venography (A) and corresponding MR venography image (B) show loss of flow signal in superior sagittal sinus (arrows) and increased flow through collaterals (arrowheads, A and short arrows, B). Note progression of thrombus to involve posterior portion of superior sagittal sinus on MR venography (B), which was performed 24 hours after CT venography (A).

 

Figure 13
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  		Fig. 5B —28-year-old postpartum woman with sudden loss of consciousness. Sagittal maximum-intensity-projection image of CT venography (A) and corresponding MR venography image (B) show loss of flow signal in superior sagittal sinus (arrows) and increased flow through collaterals (arrowheads, A and short arrows, B). Note progression of thrombus to involve posterior portion of superior sagittal sinus on MR venography (B), which was performed 24 hours after CT venography (A).

 

Figure 14
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  		Fig. 6 —45-year-old man with new onset of seizures. CT venography multiplanar reconstructed coronal image shows filling defects in superior sagittal sinus (arrowhead) and left sigmoid sinus (arrow).

 

Figure 15
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  		Fig. 7A —18-year-old woman with sudden onset of headache and straight sinus thrombosis. Three-dimensional CT venogram obtained using integral algorithm shows filling defect in straight sinus (arrowheads).

 

Figure 16
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  		Fig. 7B —18-year-old woman with sudden onset of headache and straight sinus thrombosis. Corresponding maximum-intensity-projection MR image shows loss of signal in straight sinus (arrow).

 

Figure 17
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  		Fig. 8A —25-year-old man who presented with sudden loss of consciousness. Three-dimensional CT venography images with integral algorithm show filling defect in posterior part of superior sagittal sinus and normal anterior part (arrow, A) as well as filling defects in superior sagittal sinus and left transverse sinus (arrows, B).

 

Figure 18
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  		Fig. 8B —25-year-old man who presented with sudden loss of consciousness. Three-dimensional CT venography images with integral algorithm show filling defect in posterior part of superior sagittal sinus and normal anterior part (arrow, A) as well as filling defects in superior sagittal sinus and left transverse sinus (arrows, B).

 

Figure 19
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  		Fig. 8C —25-year-old man who presented with sudden loss of consciousness. Corresponding MR venography maximum-intensity-projection image shows loss of flow signal in superior sagittal sinus and straight sinus and increased flow through collaterals.

 

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