Thromb Haemost 2018; 118(06): 1067-1077
DOI: 10.1055/s-0038-1642636
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH Stuttgart

The Performance of CT versus MRI in the Differential Diagnosis of Cerebral Venous Thrombosis

Weilin Xu
1   Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
,
Liansheng Gao
1   Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
,
Tao Li
1   Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
,
Neha Darshana Ramdoyal
2   School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
,
Jianmin Zhang
1   Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
3   Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China
4   Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China
,
Anwen Shao
1   Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
› Author Affiliations
Funding This work was funded by China Postdoctoral Science Foundation (2017M612010) and National Natural Science Foundation of China (81701144).
Further Information

Publication History

08 June 2017

21 March 2018

Publication Date:
25 April 2018 (online)

Abstract

Background Cerebral venous thrombosis (CVT) is a rare disease, and with poor prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used image modalities for patients with non-specific neurologic symptoms. We present here a meta-analysis to assess the accuracy of CT and MRI in the differential diagnosis of CVT and cerebral venous sinus thrombosis (CVST).

Materials and Methods A comprehensive search of the PubMed, EMBASE, Web of Science, Cochrane Database and Chinese Biomedical (CBM) databases was conducted prior to March 20, 2017. In this report, we assess the methodological quality of each article individually and perform a meta-analysis to obtain the summary of the diagnostic accuracy of CT and MRI in correctly identifying CVT and CVST.

Results Twenty-four eligible articles comprising 48 studies (4,595 cases) were included. The pooled sensitivity for CT–CVT/CT–CVST groups is 0.79 (95% confidence interval [CI]: 0.76, 0.82)/0.81(95% CI: 0.78, 0.84), and pooled specificity is 0.90 (95% CI: 0.89, 0.91)/0.89 (0.88, 0.91), with an area under the curve (AUC) for the summary receiver operating characteristic (SROC) of 0.9314/0.9161, respectively. No significant heterogeneity and publication bias was observed across each study. For MRI–CVT/MRI–CVST, the pooled sensitivity is 0.82 (95% CI: 0.78, 0.85)/0.80 (95% CI: 0.76, 0.83), and pooled specificity is 0.92 (95% CI: 0.91, 0.94)/0.91(0.89, 0.92), with an AUC for the SROC of 0.9221/0.9273, respectively.

Conclusion This meta-analysis indicates that both CT and MRI have a high level of diagnostic accuracy in the differential diagnosis of CVT and CVST, independent of stage, target for analysis or analysis methods. They could be chosen as alternative sub-optimal gold standards for diagnosing CVT and CVST, especially in emergency.

Note

Weilin Xu, Liansheng Gao and Tao Li have equally contributed to this work as co-first authors. Jianmin Zhang and Anwen Shao have equally contributed to this work as corresponding authors.


Supplementary Material

 
  • References

  • 1 Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352 (17) 1791-1798
  • 2 Tang PH, Chai J, Chan YH, Chng SM, Lim CC. Superior sagittal sinus thrombosis: subtle signs on neuroimaging. Ann Acad Med Singapore 2008; 37 (05) 397-401
  • 3 Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6 (02) 162-170
  • 4 Piazza G. Cerebral venous thrombosis. Circulation 2012; 125 (13) 1704-1709
  • 5 Renowden S. Cerebral venous sinus thrombosis. Eur Radiol 2004; 14 (02) 215-226
  • 6 Linn J, Pfefferkorn T, Ivanicova K. , et al. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. Am J Neuroradiol 2009; 30 (04) 728-735
  • 7 Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000; 247 (04) 252-258
  • 8 Virapongse C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 1987; 162 (03) 779-785
  • 9 Connor SE, Jarosz JM. Magnetic resonance imaging of cerebral venous sinus thrombosis. Clin Radiol 2002; 57 (06) 449-461
  • 10 Zhang Q, Zeng X, Yao Z. The diagnostic value of MRI and MRV in cerebral venous and sinus thrombosis. Anhui Med J 2014; 11: 1512-1514
  • 11 Khandelwal N, Agarwal A, Kochhar R. , et al. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol 2006; 187 (06) 1637-1643
  • 12 Saposnik G, Barinagarrementeria F, Brown Jr RD. , et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192
  • 13 Whiting PF, Rutjes AW, Westwood ME. , et al; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155 (08) 529-536
  • 14 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
  • 15 Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM. ; Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Ann Intern Med 2008; 149 (12) 889-897
  • 16 Swets JA. Measuring the accuracy of diagnostic systems. Science 1988; 240 (4857): 1285-1293
  • 17 Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006; 6: 31
  • 18 Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005; 58 (09) 882-893
  • 19 Zhao C, Zhang Y, Wang J. A meta-analysis on the diagnostic performance of (18)F-FDG and (11)C-methionine PET for differentiating brain tumors. Am J Neuroradiol 2014; 35 (06) 1058-1065
  • 20 Liu L. The diagnostic value of CT and MRI in cerebral venous sinus thrombosis. Contemporary Med 2017; 23: 103-105
  • 21 Huang Z, Lin L, Jiang X, Huang Z, Guan J. Unenhanced CT density of cerebral venous sinus in acute cerebral venous sinus thrombosis. Diagnostic Imag Intervention Radiol 2016; 25: 50-54
  • 22 Zaheer S, Iancu D, Seppala N. , et al. Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis. Neuroradiology 2016; 58 (07) 657-663
  • 23 Yang Q, Duan J, Fan Z. , et al. Early detection and quantification of cerebral venous thrombosis by magnetic resonance black-blood thrombus imaging. Stroke 2016; 47 (02) 404-409
  • 24 Niu PP, Yu Y, Guo ZN. , et al. Diagnosis of non-acute cerebral venous thrombosis with 3D T1-weighted black blood sequence at 3T. J Neurol Sci 2016; 367: 46-50
  • 25 Avsenik J, Oblak JP, Popovic KS. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis. Radiol Oncol 2016; 50 (03) 263-268
  • 26 Jalli R, Zarei F, Farahangiz S. , et al. The sensitivity, specificity, and accuracy of contrast-enhanced T1-weighted image, T2*-weighted image, and magnetic resonance venography in diagnosis of cerebral venous sinus thrombosis. J Stroke Cerebrovasc Dis 2016; 25 (08) 2083-2086
  • 27 Bidar F, Faeghi F, Ghorbani A. Assessment of cerebral venous sinus thrombosis using T2 (*)-weighted gradient echo magnetic resonance imaging sequences. Iran J Neurol 2016; 15 (02) 96-99
  • 28 Patel D, Machnowska M, Symons S. , et al. Diagnostic performance of routine brain MRI sequences for dural venous sinus thrombosis. Am J Neuroradiol 2016; DOI: 10.3174/ajnr.A4843.
  • 29 Chik Y, Gottesman RF, Zeiler SR, Rosenberg J, Llinas RH. Differentiation of transverse sinus thrombosis from congenitally atretic cerebral transverse sinus with CT. Stroke 2012; 43 (07) 1968-1970
  • 30 Sari S, Verim S, Hamcan S. , et al. MRI diagnosis of dural sinus - cortical venous thrombosis: immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences. Clin Neurol Neurosurg 2015; 134: 44-54
  • 31 Sadigh G, Mullins ME, Saindane AM. Diagnostic performance of MRI sequences for evaluation of dural venous sinus thrombosis. Am J Roentgenol 2016; 206 (06) 1298-1306
  • 32 Alsafi A, Lakhani A, Carlton Jones L, Lobotesis K. Cerebral venous sinus thrombosis, a nonenhanced CT diagnosis?. Radiol Res Pract 2015; 2015: 581437
  • 33 Guan J, Lin L, Huang Z, Chu J, Yang Z. Is it possible to accurately diagnose cerebral venous sinus thrombosis on non-contrast CT?. Diagnostic Imag Intervention Radiol 2015; 24: 9-13
  • 34 Garetier M, Rousset J, Pearson E. , et al. Value of spontaneous hyperdensity of cerebral venous thrombosis on helical CT. Acta Radiol 2014; 55 (10) 1245-1252
  • 35 Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. Am J Neuroradiol 2013; 34 (08) 1568-1572
  • 36 Besachio DA, Quigley III EP, Shah LM, Salzman KL. Noncontrast computed tomographic Hounsfield unit evaluation of cerebral venous thrombosis: a quantitative evaluation. Neuroradiology 2013; 55 (08) 941-945
  • 37 Saindane AM, Mitchell BC, Kang J, Desai NK, Dehkharghani S. Performance of spin-echo and gradient-echo T1-weighted sequences for evaluation of dural venous sinus thrombosis and stenosis. Am J Roentgenol 2013; 201 (01) 162-169
  • 38 Black DF, Rad AE, Gray LA, Campeau NG, Kallmes DF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. Am J Neuroradiol 2011; 32 (07) 1354-1357
  • 39 Roland T, Jacobs J, Rappaport A, Vanheste R, Wilms G, Demaerel P. Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis. Clin Radiol 2010; 65 (01) 34-39
  • 40 Gaikwad AB, Mudalgi BA, Patankar KB, Patil JK, Ghongade DV. Diagnostic role of 64-slice multidetector row CT scan and CT venogram in cases of cerebral venous thrombosis. Emerg Radiol 2008; 15 (05) 325-333
  • 41 Meckel S, Reisinger C, Bremerich J. , et al. Cerebral venous thrombosis: diagnostic accuracy of combined, dynamic and static, contrast-enhanced 4D MR venography. Am J Neuroradiol 2010; 31 (03) 527-535
  • 42 Nakajima T, Kumabe T, Kanamori M. , et al. Differential diagnosis between radiation necrosis and glioma progression using sequential proton magnetic resonance spectroscopy and methionine positron emission tomography. Neurol Med Chir (Tokyo) 2009; 49 (09) 394-401
  • 43 Ihn YK, Jung WS, Hwang SS. The value of T2*-weighted gradient-echo MRI for the diagnosis of cerebral venous sinus thrombosis. Clin Imaging 2013; 37 (03) 446-450
  • 44 Lafitte F, Boukobza M, Guichard JP. , et al. MRI and MRA for diagnosis and follow-up of cerebral venous thrombosis (CVT). Clin Radiol 1997; 52 (09) 672-679
  • 45 Leach JL, Wolujewicz M, Strub WM. Partially recanalized chronic dural sinus thrombosis: findings on MR imaging, time-of-flight MR venography, and contrast-enhanced MR venography. Am J Neuroradiol 2007; 28 (04) 782-789
  • 46 Rodallec MH, Krainik A, Feydy A. , et al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics 2006; 26 (Suppl. 01) S5-S18
  • 47 Teasdale E. Cerebral venous thrombosis: making the most of imaging. J R Soc Med 2000; 93 (05) 234-237