Which imaging modalities are recommended for the diagnosis of CVST, and how should I interpret the results?

Recommended imaging modalities for diagnosing cerebral venous sinus thrombosis (CVST) include magnetic resonance imaging (MRI) combined with magnetic resonance venography (MRV), and computed tomography venography (CTV). MRI with MRV is preferred due to its high sensitivity and specificity in detecting thrombus within the cerebral venous sinuses and its ability to assess associated brain parenchymal changes such as venous infarction or haemorrhage ¹. CTV is an alternative when MRI is contraindicated or unavailable, providing rapid and reliable visualization of venous sinus occlusion ¹.

Interpretation of imaging results involves identifying absence of flow or filling defects within the cerebral venous sinuses, which indicate thrombosis. On MRI, thrombus may appear as altered signal intensity on T1- and T2-weighted images, with MRV showing absence or irregularity of flow signal in affected sinuses ¹. On CTV, a filling defect or absence of contrast opacification in the venous sinuses confirms thrombosis ¹.

Cerebral angiography, historically considered the gold standard, is now reserved for cases where non-invasive imaging is inconclusive or when endovascular intervention is planned, due to its invasive nature and associated risks (Janjua, 2006). Additionally, recent literature highlights the importance of correlating imaging findings with clinical presentation and considering differential diagnoses such as cavernous sinus lesions, which may mimic CVST on imaging (Mahalingam et al., 2019).