CSVT in Children

Summarized by: Nadiv Hossain

Reviewed by: Elton Law, M.D.

Original publication details

Authors: Chiara Carducci, Giovanna Stefania Colafati, Lorenzo Figà‐Talamanca, Daniela Longo, Tommaso Lunardi, Francesco Randisi, Bruno Bernardi

DOI: https://doi.org/10.1007/s11547-016-0630-9

Reference: Carducci, C., Colafati, G. S., Figà-Talamanca, L., Longo, D., Lunardi, T., Randisi, F., & Bernardi, B. (2016). Cerebral sinovenous thrombosis (CSVT) in children: What the Pediatric Radiologists Need To Know. La Radiologia Medica, 121(5), 329–341.

Noncontrast CT

Findings

The “dense clot sign” (hyperattenuating thrombus in the partially or totally occluded sinus) is the only direct finding suggestive of thrombosis on unenhanced CT. If found, it warrants CT venography and/or MR venography

This sign is usually present in the acute/subacute phase, beyond which the clot becomes less dense

False positives can occur with this sign if the patient is hemo-concentrated with a high hematocrit level causing the blood in the sinus to appear more dense

Indirect signs include focal distension of dural venous compartment, hyperattenuation of internal cerebral veins, and hemorrhagic parenchymal infarction in the drainage area of obstructed vein/sinus

CT venography

Findings

“Empty delta sign” = central intraluminal thrombus with enhancing dura surrounding the non-enhancing thrombus

MR/MR venography

Findings and sequences

T1 post-contrast sequence: Filling defect in the sinus, similar to CT venography

Standard spin-echo sequences: Loss of the normal flow void secondary to thrombus

Variable signal intensity depending on the age of the thrombus

Acute stage

Thrombus predominantly isointense on T1W images and hypointense on T2W images.

Sub-acute stage

Thrombus is predominantly hyperintense on both T1W and T2W images.

Chronic stage (>15 days)

Incomplete recanalization of the sinus with the thrombus isointense on T1W images and isointense/hyperintense on T2W images.

Time of flight and phase contrast sequences: Cannot replace post-contrast sequence due to false negatives. They can be useful in the chronic stage to evaluate for patency.

DWI sequences: Evaluation for possible ischemia that can occur with CVST

MRA and MR perfusion are not routinely done for CVST

Mimics of CSVT

Congenital dominant transverse sinus with hypoplasia of the non-dominant sinus

Absent frontal superior sagittal sinus

Arachnoid granulations (typically round, short segment filling defects seen on CT/MR venography)

Venous sinus septation (fibrotic linear bands)

Citation


Carducci, C., Colafati, G. S., Figà-Talamanca, L., Longo, D., Lunardi, T., Randisi, F., & Bernardi, B. (2016). Cerebral sinovenous thrombosis (CSVT) in children: What the Pediatric Radiologists Need To Know. La Radiologia Medica, 121(5), 329–341. https://doi.org/10.1007/s11547-016-0630-9.