Quantitative assessment of the superior sagittal sinus on unenhanced computed tomography

Purpose: To determine the relationship between hemoglobin levels and attenuation measurements of the superior sagittal sinus (SSS) on unenhanced computed tomography (UECT). Secondly, to determine if SSS attenuation values are normally distributed such that measurements below and above certain thresholds are suggestive of pathology, such as anemia or acute venous thrombosis respectively. Methods: Institutional review board approval was obtained for retrospective review of adult patients having both an UECT head examination and a complete blood count within 24 h of the scan. A cohort of 151 consecutive patients formed the study sample (76 males and 75 females, 17-91 years of age with a mean of 61). The dorsal aspect of the SSS was divided into upper, middle and lower segments. Using freehand and circle region of interest (ROI) techniques, a total of six attenuation measurements were obtained from each patient. Next, statistical analyses were preformed to assess the correlation between Hgb levels and attenuation values, and distribution curves were plotted to assess the normal range of SSS attenuation measurements. Results: There is a moderate, yet statistically significant (p < 0.001), correlation between Hgb levels and attenuation values in upper, middle and lower segments of the SSS (r = 0.487, 0.497 and 0.533 respectively). Based on the calculated mean, median and mode, the attenuation values are normally distributed. When using the freehand ROI technique, the mean value is 50 Hounsfield Units (HU) with a standard deviation (SD) of 7.5. Attenuation values less than 2 SDs (35 HU) are highly suggestive of anemia (specificity and PPV = 100%). Conclusion: There is a moderate, yet statistically significant, correlation between Hgb levels and attenuation of the SSS on UECT. Furthermore, attenuation measurements of the SSS are normally distributed with a mean of 50 HU and a SD of 7.5. Therefore, quantitative assessment of the SSS may prove useful in the clinical practice of a radiologist; namely, in the diagnosis of anemia and acute venous thrombosis. (C) 2009 Elsevier Ireland Ltd. All rights reserved.