Imaging features in patients with cerebral venous thrombosis associated with a poor prognosis
| Imaging feature | Explanation | Prognostic impact |
| Imaging findings related to the thrombus | ||
| Deep vein thrombosis | Thrombus location in one or more of the deep veins | Independent predictor of death or dependence (median follow-up 16 months)11 |
| DWI hyperintensity of the thrombus | Hyperintense signal of the thrombus on baseline DWI-MRI | Complete recanalization at 2–3 months is less common in patients with DWI-hyperintense thrombi treated with anticoagulation37 |
| Parenchymal imaging findings | ||
| Low cerebral blood volume (CBV) and cerebral blood flow (rCBF), prolonged relative mean transit time (MTT) | Decrease in relative CBV and relative CBF on CT perfusion and prolongation of relative MTT in the center of the affected venous territory (compared with unaffected parenchyma) | Only mildly decreased relative CBV (>75.5%) and relative CBF (>60.5%), and only mildly prolonged relative MTT (<148.5%) were associated with better clinical outcomes at 30 days compared with patients with lower relative CBV and CBF/more severe MTT prolongation25 |
| Intracranial hemorrhage | Any form of intracranial hemorrhage (eg, parenchymal, subarachnoid) at baseline imaging | Independent predictor of death or dependence (median follow-up 16 months)11 |
| 'Venous congestion'* | Defined either clinically as worsening of symptoms despite anticoagulation therapy, or radiologically as intracranial hemorrhage or edema on CT or MRI. | For patients fulfilling the criteria of venous congestion, standard treatment with anticoagulants is not sufficient and they need rescue treatment more often24 |
*Combined clinical and radiological definition in the study by Tsai et al. 24
DWI, diffusion weighted imaging.