PT  - JOURNAL ARTICLE
AU  - S. Meckel
AU  - C. Reisinger
AU  - J. Bremerich
AU  - D. Damm
AU  - M. Wolbers
AU  - S. Engelter
AU  - K. Scheffler
AU  - S.G. Wetzel
TI  - Cerebral Venous Thrombosis: Diagnostic Accuracy of Combined, Dynamic and Static, Contrast-Enhanced 4D MR Venography
AID  - 10.3174/ajnr.A1869
DP  - 2010 Mar 01
TA  - American Journal of Neuroradiology
PG  - 527--535
VI  - 31
IP  - 3
4099  - http://www.ajnr.org/content/31/3/527.short
4100  - http://www.ajnr.org/content/31/3/527.full
SO  - Am. J. Neuroradiol.2010 Mar 01; 31
AB  - BACKGROUND AND PURPOSE: MR including MRV is an established method to diagnose CVT. However, it remains unsettled which MR imaging modalities offer the highest diagnostic accuracy. We evaluated the accuracy of a combined, dynamic (1.5 seconds per dataset) and static (voxel size, 1.1 × 0.9 × 1.5 mm), contrast-enhanced MRV method (combo-4D MRV) relative to other established MR/MRV modalities. MATERIALS AND METHODS: A total of 39 patients with CVT (n = 20) and control subjects (n = 19) underwent combo-4D MRV, 2D TOF MRV, GRE imaging, and T2W imaging. For these modalities, diagnostic accuracy (ROCs) for CVT affecting 53 out of 234 predefined venous segments was determined. Sensitivity and specificity were separately calculated for different stages of CVT (acute/subacute/chronic). RESULTS: Combo-4D MRV showed the highest accuracy (AUC, 0.99 [95% CI, 0.97–1.0]; sensitivity, 97% [84%–100%]) for thrombosed dural sinuses. For all thrombosed segments including cortical veins, its sensitivity was best (76% [64%–84%]; AUC, 0.92 [0.88–0.96]), followed by TOF MRV (72% [59%–81%]; AUC, 0.93 [0.88–0.97]). Even for chronic CVT, it showed a relatively high sensitivity of 67% (30%–90%). For thrombosed cortical veins alone, GRE images achieved the highest sensitivity (66% [46%–81%]; AUC, 0.88 [0.78–0.97]). Specificities of all modalities ranged from 96% to 99%. CONCLUSIONS: Combo-4D MRV showed an excellent accuracy for the diagnosis of dural sinus thrombosis. The analysis of dynamic patterns of contrast enhancement in dural sinuses appeared useful to identify chronic thrombosis. To diagnose thrombosed cortical veins, GRE images should primarily be analyzed. AFacceleration factorAUCarea under the respective reader-specific ROC curveCIconfidence intervalCVTcerebral venous thrombosisDSAdigital subtraction angiographyFAflip angleGREgradient recalled-echoMRVMR venographyNAnumber of averagesMIPmaximum intensity projectionMPRAGEmagnetization-prepared rapid acquisition of gradient echoROCreceiver operating characteristicT2WT2-weightedTAacquisition timeTOFtime-of-flightVIBEvolumetric interpolated brain examinationTSEturbo spin-echo