DIAGNOSTIC VALUE OF VENOUS -ARTERIAL ATTENUATION RATIO AND HOUNSFIELD-HEMATOCRIT RATIO IN THE EVALUATION OF ACUTE CEREBRAL VENOUS SINUS THROMBOSIS IN NON-CONTRAST BRAIN COMPUTED TOMOGRAPHY

Abstract

<strong>Background:</strong> Elevated density of the venous sinuses is a typical sign of cerebral venous sinus thrombosis (CVST) on non-contrast brain computed tomography (NCBCT). The purpose of this study was to assess the diagnostic value of V:A and H:H ratios for diagnosis of acute CVST in NBCT.

<strong>Materials and Methods:</strong> This retrospective case-control study included 50 confirmed cases of patients with CVST by using contrast-enhanced MR venography and 73 cases age- and sex-matched without CVST. Two blinded experienced observers independently interpreted the images for the presence of acute CVST and obtained attenuation values and V:A and H:H ratios for thrombosed and non-thrombosed sinuses on brain NCCT.

<strong>Results:</strong> A significant difference in the average sinus attenuation was found between patients with acute cerebral venous sinus thrombosis (65.8±6.4 HU) and the control group (44.9±6.2 HU; P < .0001). A similar difference was found for the H:H ratio (1.69±0.32 vs 1.25 ± 0.25) and V:A ratio (2.07±0.55 vs 1.1±0.2) in patients with and without CVST, respectively; (P < .0001). Optimal thresholds of 55 HU lead to sensitivities of 92% and specificities of 96% for average sinus attenuation and 1.37 lead to sensitivities of 88% and specificities of 77% for the H:H ratio and 1.43 lead to sensitivities of 100% and specificities of 93.8% for the V:A ratio.

<strong>Conclusions:</strong> Increased attenuation and the H:H ratio and V:A ratio in the dural sinuses on non-contrast brain computed tomography have a high sensitivity and specificity in diagnosis of acute cerebral venous sinus thrombosis.