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Research ArticleADULT BRAIN

Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis

D. Patel, M. Machnowska, S. Symons, R. Yeung, A.J. Fox, R.I. Aviv and P. Jabehdar Maralani
American Journal of Neuroradiology November 2016, 37 (11) 2026-2032; DOI: https://doi.org/10.3174/ajnr.A4843
D. Patel
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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M. Machnowska
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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S. Symons
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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R. Yeung
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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A.J. Fox
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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R.I. Aviv
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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P. Jabehdar Maralani
aFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Article Figures & Data

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    Fig 1.

    Patient selection and image separation.

  • Fig 2.
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    Fig 2.

    Etiology or underlying condition based on electronic medical records. SDH indicates subdural hemorrhage; IPH, intraparenchymal hemorrhage; DAVF, dural arteriovenous fistula.

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    Fig 3.

    Indications for imaging based on the imaging requisition form. SDH indicates subdural hemorrhage; IPH, intraparenchymal hemorrhage.

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    Fig 4.

    MR imaging signs of dural venous sinus thrombosis from multiple cases. A, Hyperintense signal in the right transverse sinus on sagittal T1. B, Loss of flow void in the right transverse sinus on axial T2. C, Hyperintense signal in the right transverse sinus on FLAIR. D, Hyperintense signal in the right transverse sinus on DWI. E, Blooming artifacts in the right transverse sinus on GRE. F, Filling defect in the right transverse/sigmoid sinus on CE-SE-T1WI. G, Filling defect in the right transverse/sigmoid sinus on CE-3D-T1WI. H, Filling defect in the right transverse/sigmoid sinus on CTV. I, Filling defect in the right transverse/sigmoid sinus on MIP-CEMRV.

Tables

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    Table 1:

    Patient characteristics

    DVST (n = 72)Non-DVST (n = 357)Total (n = 429)
    Age (yr) (mean)51.4 ± 16.845.8 ± 17.046.7 ± 17.1
    Female (No.) (%)45 (62.5)239 (66.9)284 (66.2)
    3T MRI (No.) (%)16 (22.2)130 (36.4)146 (34.0)
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    Table 2:

    Performance of routine MRI sequences compared with CEMRV or CTV for each reader

    Sensitivity (%)Specificity (%)Accuracy (%)
    Reader 184.7a82.182.5
    Reader 270.891.4b87.7b
    Reader 372.284.382.3
    • ↵a Statistically significant compared with reader 2 (P < .05).

    • ↵b Statistically significant compared with readers 1 and 3 (P < .05).

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    Table 3:

    Performance of MRI for the detection of DVST compared with CEMRV or CTV based on the most votes

    Sensitivity (%)Specificity (%)
    MRI total (n = 429)79.289.9
    MRI total for 1.5T (n = 283)85.7a87.2
    MRI total for 3T (n = 146)56.3b94.6c
    • ↵a Statistically significant compared with MRI Total (P < .05).

    • ↵b Statistically significant compared with MRI Total and 1.5T (P < .05).

    • ↵c Statistically significant compared with 1.5T (P < .05).

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    Table 4:

    Interrater reliability for each MRI sequence individually and combined using the κ coefficient

    κAgreementa
    Sagittal T1 (n = 418)0.28Fair
    Axial T2 (n = 71)0.34Fair
    Axial GRE (n = 420)0.40Fair
    Axial FLAIR (n = 417)0.34Fair
    Axial DWI (n = 421)0.33Fair
    Axial CE-SE-T1WI (n = 241)0.42Moderate
    Axial CE-3D-T1WI (n = 199)0.41Moderate
    MRI total (n = 429)0.50Moderate
    • ↵a Agreement was considered slight if κ values were 0–0.20; fair if, 0.21–0.40; moderate if, 0.41–0.60; substantial if, 0.61–0.80; and almost perfect if, 0.81–1.

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American Journal of Neuroradiology: 37 (11)
American Journal of Neuroradiology
Vol. 37, Issue 11
1 Nov 2016
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D. Patel, M. Machnowska, S. Symons, R. Yeung, A.J. Fox, R.I. Aviv, P. Jabehdar Maralani
Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis
American Journal of Neuroradiology Nov 2016, 37 (11) 2026-2032; DOI: 10.3174/ajnr.A4843

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Diagnostic Performance of Routine Brain MRI Sequences for Dural Venous Sinus Thrombosis
D. Patel, M. Machnowska, S. Symons, R. Yeung, A.J. Fox, R.I. Aviv, P. Jabehdar Maralani
American Journal of Neuroradiology Nov 2016, 37 (11) 2026-2032; DOI: 10.3174/ajnr.A4843
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