Pieter-Jan Buyck1, Susanna M Zuurbier1, Carlos Garcia-Esperon1, Miguel A Barboza1, Paolo Costa1, Irene Escudero1, Dimitri Renard1, Robin Lemmens1, Nicole Hinteregger1, Franz Fazekas1, Jordi Jimenez Conde1, Eva Giralt-Steinhauer1, Sini Hiltunen1, Antonio Arauz1, Alessandro Pezzini1, Joan Montaner1, Jukka Putaala1, Christian Weimar1, Leonid Churilov1, Thomas Gattringer1, Hamed Asadi1, Turgut Tatlisumak1, Jonathan M Coutinho1, Philippe Demaerel1, Vincent Thijs2. 1. From the Departments of Radiology (P.-J.B., P.D.) and Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, Amsterdam, the Netherlands; Department of Neurology (C.-G.E.), John Hunter Hospital, University of Newcastle, Australia; Stroke Department (M.A.B., A.A.), Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México City, México; Department of Head and Neck (P.C.), Neurology Unit, Fondazione Poliambulanza, Brescia, Italy; Departments of Head and Neck (P.C.) and Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Neurology Department (I.E., J.M.), University Hospitals Virgen del Rocio and Macarena, Seville; Neurovascular Lab (I.E., J.M.), Instituto de Biomedicina de Sevilla, Spain; Department of Neurology (D.R.), Nîmes University Hospital, France; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven; Laboratory of Neurobiology (R.L.), Center for Brain & Disease Research, VIB, Leuven, Belgium; Departments of Radiology (N.H.) and Neurology (F.F., T.G.), Medical University of Graz, Austria; Department of Neurology (J.J.C., E.G.-S.), Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona; Universitat Autònoma de Barcelona (J.J.C., E.G.-S.), Spain; Department of Neurology (S.H., J.P., T.T.), Helsinki University Hospital, Finland; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Department of Neurology (C.W.), University Hospital Essen, Germany; The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne; Australia School of Medicine (H.A.), Faculty of Health, Deakin University; Interventional Neuroradiology Service (H.A.), Radiology Department, Austin Health, Melbourne; Interventional Neuroradiology Service (H.A.), Radiology Department, Monash Health, Melbourne, Australia; Department of Clinical Neuroscience/Neurology (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Stroke Division, Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg; and Department of Neurology (V.T.), Austin Health, Heidelberg, Australia. 2. From the Departments of Radiology (P.-J.B., P.D.) and Neurology (R.L.), University Hospitals Leuven, Belgium; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, Amsterdam, the Netherlands; Department of Neurology (C.-G.E.), John Hunter Hospital, University of Newcastle, Australia; Stroke Department (M.A.B., A.A.), Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México City, México; Department of Head and Neck (P.C.), Neurology Unit, Fondazione Poliambulanza, Brescia, Italy; Departments of Head and Neck (P.C.) and Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Neurology Department (I.E., J.M.), University Hospitals Virgen del Rocio and Macarena, Seville; Neurovascular Lab (I.E., J.M.), Instituto de Biomedicina de Sevilla, Spain; Department of Neurology (D.R.), Nîmes University Hospital, France; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven; Laboratory of Neurobiology (R.L.), Center for Brain & Disease Research, VIB, Leuven, Belgium; Departments of Radiology (N.H.) and Neurology (F.F., T.G.), Medical University of Graz, Austria; Department of Neurology (J.J.C., E.G.-S.), Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona; Universitat Autònoma de Barcelona (J.J.C., E.G.-S.), Spain; Department of Neurology (S.H., J.P., T.T.), Helsinki University Hospital, Finland; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Department of Neurology (C.W.), University Hospital Essen, Germany; The Florey Institute of Neuroscience and Mental Health (L.C.), University of Melbourne; Australia School of Medicine (H.A.), Faculty of Health, Deakin University; Interventional Neuroradiology Service (H.A.), Radiology Department, Austin Health, Melbourne; Interventional Neuroradiology Service (H.A.), Radiology Department, Monash Health, Melbourne, Australia; Department of Clinical Neuroscience/Neurology (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Stroke Division, Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg; and Department of Neurology (V.T.), Austin Health, Heidelberg, Australia. vincent.thijs@florey.edu.au.
Abstract
OBJECTIVE: To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT). METHODS: In a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations. RESULTS: We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74-0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74-0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8-0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70-0.81). CONCLUSION: Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.
OBJECTIVE: To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT). METHODS: In a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations. RESULTS: We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74-0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74-0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8-0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70-0.81). CONCLUSION: Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.
Authors: Andrea Romano; Maria Camilla Rossi-Espagnet; Luca Pasquini; Alberto Di Napoli; Francesco Dellepiane; Giulia Butera; Giulia Moltoni; Olga Gagliardo; Alessandro Bozzao Journal: Tomography Date: 2021-12-22
Authors: Jingwei Zhang; Kang Peng; Fenghui Ye; Sravanthi Koduri; Ya Hua; Richard F Keep; Guohua Xi Journal: Transl Stroke Res Date: 2021-06-02 Impact factor: 6.829