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Present status of computerized tomography and angiography in the diagnosis of cerebral thrombophlebitis cavernous
R Anxionnat1, B Blanchet, D Dormont
1Service de Neuroradiologie Diagnostique et Thérapeutique, CHRU Nancy.
Insights
Computerized tomography (CT) can detect cerebral thrombophlebitis with direct signs like the "cord sign" and "delta sign," but MRI is the key diagnostic tool. Angiography is reserved for complex cases where MRI is not feasible.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Cerebral thrombophlebitis diagnosis relies on various imaging modalities.
- Computerized tomography (CT) plays a role, but its limitations necessitate further investigation.
Purpose of the Study:
- To evaluate the diagnostic contribution of CT in cerebral thrombophlebitis.
- To compare CT findings with literature data and other advanced imaging techniques.
Main Methods:
- Retrospective review of 28 cerebral thrombophlebitis cases.
- Comparison of CT findings (direct and indirect signs) with published data.
- Discussion of the roles of MRI and angiography in diagnosis.
Main Results:
- Direct CT signs like the 'cord sign' (2%) and 'delta sign' (16-30%) are observed.
- Indirect signs include cerebral edema (12-52%) and venous ischemia (22-59%).
- CT scans can be normal in 3.6-26% of cases, highlighting the need for advanced imaging.
Conclusions:
- MRI is the primary modality for diagnosing cerebral thrombophlebitis due to its non-invasiveness and sensitivity.
- CT provides useful, but often insufficient, diagnostic clues.
- Angiography remains valuable for specific challenging cases and purely cortical thrombophlebitis.
Abstract:
In order to evaluate the contribution of computerized tomography (CT) to the diagnosis of cerebral thrombophlebitis, a series of 28 cases was reviewed and compared with data from the literature. In an examination carried out 4 to 5 days of its constitution the thrombus may be directly visualized as a spontaneous hyperdensity. This early but very transient sign, called "cord sign", can easily be overlooked, which explains why it was found in only 5 of our 28 cases and in 2% of the largest series of the literature. The thrombus thereafter becomes hypodense and can be intensified by peripheral contrast enhancement which produces the classical "delta sign". This sign is more frequent: 13/28 in our series and 16 to 30% in published cases. It is usually found in the superior sagittal sinus and must be distinguished from anatomical variations which are common at that level. These two direct signs acquire a greater value when associated with such indirect signs as diffuse or localized cerebral oedema (12 to 52%) and venous ischaemia (22 to 59%). Venous ischaemia is characterized by its strong bleeding potential (more than 50% of the cases) and by its usually favourable course; these two elements and its site differentiate it from arterial ischaemia. Finally, venous stasis is responsible, in 5 to 19% of the cases, for intense enhancement of the tentorium cerebelli; this sign is not specific but easy to evidence and of great value when associated with a direct sign. Dilatation of cortical veins, found in 4 of our 28 cases, also seems to be an interesting sign which, to our knowledge, has not yet been mentioned in the literature. Since in 3.6 to 26% of the cerebral thrombophlebitis the CT scan is normal, a negative CT examination does not rule out this disease, and in many cases the exploration must be rapidly completed by angiography or MRI. Because it is non-invasive and very sensitive to flows, MRI has become the key examination to assert the diagnosis. Angiography is now restricted to those cases where cases where MRI cannot be performed promptly or to certain, purely cortical thrombophlebitis which might pass unnoticed at MRI. When carried out and interpreted cautiously, angiography always shows the venous thrombosis, its exact size and its suppletive network. The results of this study show that MRI alone can diagnose cerebral thrombophlebitis in most patients, that CT well done and interpreted often provides useful but seldom sufficient indices, and that angiography should be reserved for difficult cases.