Prognostic indices for cerebral venous thrombosis on CT perfusion: A prospective study

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Abstract

Purpose

We determined the prognostic significance of CT perfusion characteristics of patients with cerebral venous sinus thrombosis (CVST) and assessed the change in perfusion parameters following anticoagulation therapy.

Materials and methods

20 patients with CVST diagnosed on non-contrast computed tomography (NCCT), magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) were included in this study. The initial CT perfusion study was performed at the time of admission. The following perfusion parameters: relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and relative mean transit time (rMTT) were calculated in the core and periphery of the affected area of the brain. Follow-up CT perfusion studies were performed at 1 month following anticoagulation therapy and the perfusion parameters thus obtained were compared with pre-treatment results. Receiver operating characteristic (ROC) curve analysis was performed to determine the prognostic significance of perfusion parameters.

Results

All patients in this study showed areas of hypoperfusion on CT perfusion. To determine the favorable clinical outcome on basis of perfusion parameters, ROC curve analysis was performed which showed that the optimal threshold for rCBF > 60.5%, rCBV > 75.5%, and rMTT < 148.5% correlated with better clinical outcomes. Post treatment perfusion parameters showed significant correlation in core of the lesion (p < 0.05) than in the periphery.

Conclusion

CT perfusion studies in CVST are a good prognostic tool and yield valuable information regarding clinical outcome.

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.

Section snippets

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)

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