Cortical vein thrombosis: the diagnostic value of different imaging modalities

Cortical vein thrombosis (CVT) is a rare disorder, and its diagnosis is challenging. The aim of our study was to evaluate the value of different imaging modalities for the detection of CVT. Thirteen patients with CVT, either isolated (n = 3) or in combination with sinus thrombosis (n = 10), and 20 control patients without any venous pathologies were included in this study. The analysis was performed independently by three blinded readers who evaluated the following imaging modalities and sequences separately: non-enhanced computed tomography (NCCT); multi-detector row CT angiography (MDCTA); diffusion-weighted (DWI), T1-weighted (T1w), PD-weighted (PDw), T2*-weighted (T2*w), and fluid-attenuated inversion recovery-weighted (FLAIRw) magnetic resonance (MR) sequences; as well as venous MR angiography (vMRA). The sensitivity, specificity, positive (PPV) and negative predictive values, and interobserver agreement of the different modalities were calculated. T2*w showed the highest sensitivity for the detection of CVT (97.4%), followed by T1w (70%). FLAIRw and vMRA had a sensitivity of 50% and 41.7%, respectively, whereas the sensitivity of NCCT, MDCTA, DWI, and PDw was below 30%. The specificity and PPV of all modalities was 100%, with good to perfect interobserver agreement. T2*w was the superior MR imaging sequence for diagnosing CVT. Besides T2*w, only T1w reached a sensitivity of over 50% for CVT, followed by FLAIRw, and vMRA. On the contrary, our results suggest that NCCT but also MDCTA might not be suitable for diagnosing CVT. (orig.)