Cerebral venography: comparison of CT and MR projection venography

The purpose of the study was to show equivalence or superiority of CT venography compared with the existing test of choice--MR venography--in the evaluation of dural sinus thrombosis and in the identification of cerebral veins and dural sinuses.

Twenty-four patients underwent both CT and MR venography of the intracranial venous circulation. Seventeen patients were examined for suspected dural sinus thrombosis. Four patients underwent projection venography to assess tumor invasion of a major dural sinus. The remaining three patients were examined for cavernous sinus thrombosis, arteriovenous malformation, and an elevated jugular bulb. Without knowledge of the patients' case histories, two radiologists evaluated each CT venogram and MR venogram. The radiologists then arrived at a consensus regarding the absence or presence of dural sinus thrombosis. Later, the radiologists conducted a second interpretation with knowledge of the patients' clinical histories during which time MR and CT venograms were compared with regard to the advantages and disadvantages of each imaging technique. In addition, the venograms were assessed for the presence of 12 different venous structure. Projection venograms were displayed using a maximum-intensity-projection (MIP) algorithm, and the individual source images were also evaluated. The CT venograms were also displayed using shell-MIP and integral display algorithms.

Using MR venography, the two radiologists diagnosed dural sinus thrombosis in eight of the 17 patients with suspected dural sinus thrombosis. In these eight patients, the diagnosis was also made with CT venography. The diagnosis was confirmed by follow-up CT in four patients and by follow-up MR imaging in two patients. The MIP algorithm did not allow direct visualization of thrombus by either the CT or the MR imaging technique; however, the CT integral display algorithm enabled direct visualization of thrombus on the three-dimensional projection venograms. The systematic comparison of imaging techniques showed that CT venography reliably reveals all cerebral veins and sinuses when they are seen with MR venography. In addition, CT venography more frequently visualizes sinuses or smaller cerebral veins with low flow as compared with MR venography.

Cerebral CT venography is superior to MR venography in the identification of cerebral veins and dural sinuses and is at least equivalent in the diagnosis of dural sinus thrombosis. CT venography is a viable alternative to MR venography in the examination of patients with suspected dural sinus thrombosis.