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Title: Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis.
Austin Authors: Buyck, Pieter-Jan;Zuurbier, Susanna M;Garcia-Esperon, Carlos;Barboza, Miguel A;Costa, Paolo;Escudero, Irene;Renard, Dimitri;Lemmens, Robin;Hinteregger, Nicole;Fazekas, Franz;Conde, Jordi Jimenez;Giralt-Steinhauer, Eva;Hiltunen, Sini;Arauz, Antonio;Pezzini, Alessandro;Montaner, Joan;Putaala, Jukka;Weimar, Christian;Churilov, Leonid ;Gattringer, Thomas;Asadi, Hamed ;Tatlisumak, Turgut;Coutinho, Jonathan M;Demaerel, Philippe;Thijs, Vincent N 
Affiliation: Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven
Department of Neurology, University Hospital Essen, Germany
Stroke Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
The Florey Institute of Neuroscience and Mental Health, University of Melbourne
Australia School of Medicine, Faculty of Health, Deakin University
Interventional Neuroradiology Service, Radiology Department, Monash Health, Melbourne, Australia
Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg
Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
Departments of Radiology and Neurology , Medical University of Graz, Austria
Department of Neurology , Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona
Universitat Autònoma de Barcelona, Spain
Department of Neurology, Helsinki University Hospital, Finland
Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
Department of Head and Neck, Neurology Unit, Fondazione Poliambulanza, Brescia, Italy
Departments of Head and Neck and Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
Neurology Department , University Hospitals Virgen del Rocio and Macarena, Seville
Neurovascular Lab, Instituto de Biomedicina de Sevilla, Spain
Department of Neurology, Nîmes University Hospital, France
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Departments of Radiology and Neurology, University Hospitals Leuven, Belgium
Department of Neurology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
Department of Neurology, John Hunter Hospital, University of Newcastle, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Feb-2019
Date: 2019-01-18
Publication information: Neurology 2019; 92(8): e841-e851
Abstract: To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT). In a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations. We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74-0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74-0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8-0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70-0.81). Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT. This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.
DOI: 10.1212/WNL.0000000000006959
ORCID: 0000-0001-8843-5890
Journal: Neurology
PubMed URL: 30659138
Type: Journal Article
Appears in Collections:Journal articles

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