Preliminary Diagnosis: Intracranial Venous Thrombosis
I. What imaging technique is first-line for this diagnosis
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CT venogram with contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of intracranial venous thrombosis.
Advantages
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Relatively inexpensive, fast imaging modality
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Excellent for assessment of any associated osseous abnormalities
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Disadvantages
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Exposes the patient to ionizing radiation
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Cannot be used to treat dural venous sinus thrombosis
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients
IV. What alternative imaging techniques are available?
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MR of the brain with contrast
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Catheter angiography of the dural venous sinuses.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of intracranial venous thrombosis.
MR of the brain with contrast
Advantages
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Does not expose the patient to ionizing radiation
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Able to detail any particular soft tissue mass, fluid collection, or vascular malformation that may be causing dural venous sinus thrombosis with great sensitivity and specificity
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Better able to differentiate arachnoid granulation from true dural venous sinus thrombosis than CT
Disadvantages
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Expensive
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Time-consuming
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Requires significant patient cooperation to minimize motion artifact
Catheter angiography of the dural venous sinuses
Advantages
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Not only able to diagnose but also treat dural venous sinus thrombosis
Disadvantages
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More invasive procedure with greater and more severe complications
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More expensive and exposes the patient to large amounts of ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
MR of the brain with contrast
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Contraindicated in patients with non-MR compatible hardware
Catheter angiography of the dural venous sinuses
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May be contraindicated in patients in a severe hypercoagulable state
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Relative contraindication in patients with renal failure
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