What is the preferred study to diagnose acute cerebral venous and sinus thrombosis?
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MRV is best if it is available in a timely manner at your facility.
If not, a CT angio can give you a good idea of the cerebral anatomy and perfusion
magnetic resonance venography
Ct venom gram
MRI with MRA; CT with CTA can also be done
CT with contrast (CT Venogram)
MRA
Ctv
MRI, or CT venogram
MRI with MRV is the PREFERRED study to diagnose a cerebral and venous sinus thrombosis. CT w/wo can be used but if undetected and high clinical suspicion, MRI is still needed. D-dimer has high correlation and higher association with degree of thrombosis, but should never be used for diagnosis. It’s use is almost as equivalent to the presence of clinical symptoms, such as a headache.
Magnetic resonance imaging (MRI) in combination with MR venography is the most sensitive examination technique for demonstrating the thrombus and the occluded dural sinus or vein
The characteristics of the MRI signal depend on the age of the thrombus
In the first five days, the thrombosed sinuses appear isointense on T1-weighted images and hypointense on T2-weighted images
Beyond five days, venous thrombus becomes more apparent because signal is increased on both T1 and T2-weighted images
uptodate.com
MRI + MRA/MRV is the most sensitive for CVT
CT is usually done first in the ED for most presentations of CVT.
So the answer depends on the definition of “preferred” – sensitive or most utilized?
“Cranial computed tomography (CCT) is usually the first investigation performed in the emergency department… Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are regarded the best tools both for the diagnosis and follow up of CVST”
http://www.springerlink.com/content/bmgbvcjaxm3dagga/
Cerebral venous and sinus thrombosis
F. Masuhr, S. Mehraein and K. Einhäupl
Journal of Neurology
Volume 251, Number 1, 11-23
There was also a recent study that demonstrated good results from Combo 4D MRV… but at that point I’d probably just ask the radiologist what they want.
http://www.ajnr.org/cgi/content/full/31/3/527
Cerebral venous thrombosis: diagnostic accuracy of combined, dynamic and static, contrast-enhanced 4D MR venography.
Meckel S, Reisinger C, Bremerich J, Damm D, Wolbers M, Engelter S, Scheffler K, Wetzel SG.
American Journal of Neuroradiology 31:527-535, March 2010
Single-slice, phase-contrast magnetic resonance angiography.
Adams WM, Laitt RD, Beards SC, et al. Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis. Eur Radiol. 1999;9(8):1614-9
Can be seen on CT but preferred method is MRI of the head with radio-contrast to show obstruction.
MRI with MRV