Diagnostic Accuracy of High-Resolution 3D T2-SPACE in Detecting Cerebral Venous Sinus Thrombosis

Coronal MR imaging from 3 different patients showing 3 phases of CVST. From left to right, FLAIR (A, F, K), T2-SPACE (B, G, L), T1-SPACE (C, H, M), CE T1-MPRAGE (D, I, N), and MIP of CE MRA (E, J, O). Thrombosed and patent veins are marked with red and green circles, respectively. The latter exhibit a physiologic flow void, clearly visible on SPACE images. Upper row, A–E, Acute CVST in a 45-year-old woman with headache and vomiting. MR imaging, performed on the day of symptom onset shows extensive thrombosis (red circles) of the transverse and sigmoid sinuses, jugular vein, torcular Herophili, and superior sagittal sinus. The flow void is absent on the T1 and T2 sequences. There are filling defects on CE-MPRAGE. The extension of the thrombosis is seen on the CE-MRA. Middle row, F–J, Subacute CVST in a 30-year-old woman who presented initially with headache. A follow-up MR imaging 13 days after the initial presentation shows thrombosis with an absent flow void on SPACE of the left transverse/sigmoid sinus and jugular vein. Lower row, K–O, Chronic CVST in a 63-year-old male patient who initially presented with headache. A follow-up MR imaging after 200 days shows a thrombus in the left transverse sinus. The flow void is absent on T2 and T1, but CVST is not detectable on CE-MPRAGE.