Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging

Background: Magnetic resonance (MR) signal changes suggestive of cerebral venous thrombosis (CVT) on T1- and T2-weighted images may be subtle and their identification requires a high degree of suspicion. Magnetic resonance venography remains essential for definitive diagnosis. Recent reports have shown that T2*-weighted MR sequence is more sensitive than T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) images in detecting subarachnoid and intracerebral hemorrhages, both of which can be seen in association with CVT. The value of T2*-weighted magnetic resonance imaging (MRI) in diagnosing CVT has not been well studied. Objectives: To investigate and describe T2* (susceptibility-weighted) MRI findings in 5 patients with CVT. Methods: We reviewed our stroke database from May 1, 1997, through May 31, 2001. The diagnosis of CVT was made in 6 patients, 5 had an MRI with T2* sequence. We examined T2*/susceptibility-weighted images for these 5 patients to determine their ability, relative to T1-weighted, T2-weighted, and FLAIR sequences, to detect CVT. Results: On T2*-weighted images, we were able to detect areas of hypointensities in the affected veins and/or sinuses in all 5 patients. Thrombosed veins and/or sinuses were more easily seen on T2*-weighted images than on any other MR sequence. The T2* sequence also allowed visualization of associated hemorrhagic venous infarcts, which were considerably less obvious on other MR sequences. Conclusions: The T2*-weighted MR sequence can be useful in rapid detection of CVT and may enable the diagnosis to be made prior to MR venography. This is particularly important in clinically unsuspected patients, in whom MR venography is rarely obtained.