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Background: Cerebral venous thrombosis (CVT) has diverse clinical presentations that are often nonspecific. Early diagnosis is crucial because early intervention, including anticoagulation and systemic or catheter-directed thrombolysis, is associated with favorable clinical outcomes. Magnetic resonance imaging (MRI) and MR venography (MRV) have become preferred techniques because of noninvasiveness with high image resolution.
Objectives: To compare the diagnostic accuracy of contrast-enhanced 3D T1-weighted high-resolution isotropic volume excitation (THRIVE) MRI sequences versus contrast-enhanced MRV for the detection of dural venous sinus (DVS) thrombosis.
Methods: Contrast-enhanced 3D THRIVE and contrast-enhanced MRV sequences of 98 patients, acquired between August 2010 and November 2012, were retrospectively reviewed by neuroradiologists for detection of DVS thrombosis in each of eight venous sinus segments (total, 784 venous segments). Diagnostic performance values were calculated for contrast-enhanced 3D THRIVE MRI sequences.
Results: Eleven patients (30 venous segments) had definite DVS thrombosis on contrast-enhanced MRV, according to neuroradiologists. Compared with contrast-enhanced MRV, the 3D THRIVE had a per-patient sensitivity and specificity of 81.8% and 92%, respectively, and a per-segment sensitivity and specificity of 90% and 98.4%, respectively. The positive predictive value of 3D THRIVE in detecting DVS thrombosis was 56.3% per patient and 69.2% per venous segment; the negative predictive value was 97.6% per patient and 99.6% per venous segment.
Conclusions: Contrast-enhanced 3D spoiled gradient-echo high-resolution T1-weighted MRI sequences (contrast-enhanced 3D THRIVE at our institution) have high diagnostic accuracy in detecting DVS thrombosis and are reliable for excluding DVS thrombosis in clinically suspected patients.
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