Prognostic indices for cerebral venous thrombosis on CT perfusion: A prospective study
Introduction
The reports in the literature highlight variations in the outcome after cerebral venous sinus thrombosis [1], [2], [3], [4], [5]. There are no standardized clinical parameters or imaging criteria which can reliably predict clinical outcome of patients of CVST
Magnetic resonance (MR) perfusion [6], Xenon computed tomography (CT) [7] and Single Photon emission computed tomography (SPECT) [8], [9] have been used to evaluate cerebral perfusion in CVST. However, all of these techniques have significant drawbacks such as limited availability and patient discomfort. There is, therefore a need for a rapid, readily available technique which can identify and quantify the presence and extent of a perfusion deficit in CVST. Perfusion CT is an easily available, reproducible quantitative imaging technique that allows rapid evaluation of cerebral circulation. The present study was performed using CT perfusion in patients of CVST to characterize the perfusion deficits and evaluate its potential as a prognostic marker.
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Material and methods
This study was approved by our institute's ethics committee. Written informed consent was obtained from the patients or their families before the patients were enrolled in the study.
Results
Out of the 20 patients included in our study, 3 were male (15%), and 17 were female (85%). The mean age was 29.6 years, with an age range from 21 to 59 years. Twelve of the patients in this study were postpartum. Most common presenting clinical symptoms was headache (n = 17).
Discussion
The goal of present study was to evaluate the CT perfusion parameters in CVST and to assess their prognostic significance. Our study comprised of 20 patients including 17 females and 3 males. In 12 of the 17 females, CVT was diagnosed in the postpartum period.
Animal models of sinus vein thrombosis [10], [11], [12], [13], [14], [15] have employed injections of thrombogenic material into the cortical veins and dural sinuses or ligation of the veins. However none of these studies employed imaging
Conclusion
CT perfusion, performed in patients of diagnosed CVST is a valuable diagnostic and prognostic tool. Parameters derived from perfusion CT could qualitatively assess the hemodynamic state of the affected portions of the brain. rCBFappears to be the best parameter to assess the perfusion deficit. Based on our results, any region of perfusion deficit showing rCBF > 60.5% and rCBV > 75.5% and rMTT < 148.5% would be associated with good prognosis. Following appropriate treatment, CT perfusion would be
Conflict of interest
I confirm that, in this research work, there was no possible conflict of interest
References (16)
- et al.
Lancet
(1991) - et al.
Single photon emission computed tomography of reversible magnetic resonance imaging abnormalities of deep cerebral venous thrombosis accompanied with malignant glioma
Surg Neurol
(2007) - et al.
Regional ischemia in cerebral venous hypertension due to embolic occlusion of the superior sagittal sinus in the rat
Surg Neurol
(1990) - et al.
Cerebral venous thrombosis: a review of 38 cases
Stroke
(1985) Cerebral venous and sinus thrombosis
Clin Neurosurg
(1966)- et al.
Deep cerebral venous system thrombosis in adults
Eur Neurol
(1990) Dural sinus and cerebral venous thrombosis
Neurosurg Rev
(1983)- et al.
Perfusion and diffusion magnetic resonance imaging in human cerebral venous thrombosis
J Neurol
(2001)
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