Lisette van Dam

Imaging modalities for diagnosing cerebral vein thrombosis 7 123 The combination of different native contrast thrombus MRI techniques had an overall sensitivity and specificity of 84-97% and 28-96%, respectively, for the diagnosis of CVT ( Appendix 4 and 5 ). 32,57,62,70-76 The comparison of these studies and interpretation of their results is complicated by the inclusion of heterogeneous patient populations and different applied MRI sequences, e.g., T1 WI, T2 WI, fluid-attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI) and proton density weighted (PDw) sequences. For the diagnosis of cortical vein thrombosis however, GRE SW MRI was consistently reported to have an adequate sensitivity of 97-98% and specificity of 100%. 21,77,78 Contrast-enhanced MRI When DSA was used as reference standard, contrast-enhanced MRI was more accurate for diagnosing cerebral sinus thrombosis than non-contrast-enhanced flow related and native contrast thrombus MR sequences, with a sensitivity and specificity of 83% and 100% versus 8-51% and 80-93%, respectively ( Appendix 4 ). 56 Other studies used the combination of multiple imaging modalities and final clinical outcome 62-64 or contrast-enhanced MRV 71 alone as reference ( Appendix 5 ). In these latter studies, contrast-enhanced MRI was also more sensitive for CVT than non-contrast-enhanced MRI, with a sensitivity and specificity of 86-97% and 52-100% versus 55-97% and 28-95%, respectively. 62-64,71 Furthermore, in studies that evaluated the diagnostic accuracy of MRI for visualization of cerebral veins (not necessarily in the setting of suspected CVT), contrast-enhanced MRI was found to be superior to non-contrast-enhanced MRI as well. 67,79-84 In a recent meta-analysis, the diagnostic accuracy of flow related MRI (MRV; contrast- and non-contrast-enhanced) for CVT was summarized. 85 Subgroup analyses of different MRV techniques confirmed that the diagnostic performance of contrast-enhanced MRV was better than that of non-contrast-enhanced TOF and PC MRV.