Detection of cerebral cortical vein thrombosis with high-resolution susceptibility weighted imaging - A comparison with MR venography and standard MR sequences.

PURPOSE: Comparison of the performance of high-resolution susceptibility weighted imaging with standard MR sequences and MR venography to identify cortical vein clots. METHODS: A retrospective review of 51 consecutive cases of cerebral venous thrombosis and 27 controls was performed with independent analysis of all MR sequences. Reference standard was obtained with consensus in a separate session by reviewing all MR sequences together. RESULTS: Cortical vein clots were observed in 30 cases including 9 males and 21 females in the age range of 1 month to 70 years (Mean 34.9 ± 20.2 years). Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of susceptibility weighted imaging for the identification of cortical vein clots were 0.93, 1.0, 1.0, 0.96 and 0.97 respectively. For all other sequences, sensitivity ranged from 0.06 to 0.39 and accuracy from 0.60 to 0.73. Combination of all sequences yielded a value of 1.0 for sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of cortical vein clots. Significant result for area under the receiver operating curve was observed only for SWI with a value of 0.91 (p - .000). CONCLUSION: Susceptibility weighted imaging demonstrates the best sensitivity and accuracy among standard MR sequences including MR venography for the detection of early stage cortical vein clots. However, it needs to be interpreted in combination with other MR sequences for the most accurate evaluation of cortical vein clots.

High-resolution susceptibility-weighted imaging of clots in cerebral venous thrombosis.

PURPOSE: To distinguish cerebral venous clots from patent dural sinuses, cortical veins, and calvarium on high-resolution susceptibility-weighted imaging, since there is lack of a well-designed study in the literature. METHODS: A retrospective review of 51 consecutive cases and 27 controls was performed with susceptibility-weighted imaging independently by two investigators. MR venography along with MR sequences other than the susceptibility-weighted imaging served as the reference standard. RESULTS: There were 29 males and 49 females in the age range of 1 month to 70 years (mean 27 ± 19.8 years). Substantial (k 0.84 to 1.0) to good (k 0.60 to 0.75) inter-rater agreement was observed on the magnitude images for the demonstration of clots in all venous segments, excluding left sigmoid sinus, jugular bulb, and internal jugular vein (k 0.43 to 0.56). Comparatively magnitude images demonstrated better sensitivity (0.83 (0.54-1.13) to 1.0), specificity (0.92 (0.85-0.99) to 1.0), and negative predictive value (0.98 (0.94-1.02) to 1.0) for the detection of clots across all venous segments. Magnitude images showed positive predictive value ranging from 0.83 (0.66-1.0) to 1.0 for clots anywhere from the anterior aspect of superior sagittal sinus to bilateral transverse sinuses. For the detection of clots from bilateral sigmoid sinuses to internal jugular veins, magnitude images showed relatively better positive predictive value ranging from 0.57 (0.20-0.94) to 0.75 (0.45-1.06) in comparison to the processed magnitude and minimum intensity pixel images. CONCLUSION: Susceptibility-weighted imaging can successfully distinguish majority of clots from patent dural sinuses, cortical veins, and calvarium with excellent inter-rater agreements.

Soft tissue attenuation in middle ear on HRCT: Pictorial review.

Middle ear disease is a common clinical entity; imaging, especially High resolution Computed Tomography (HRCT), plays a crucial role in diagnosis and assessing the disease extent, helping to decide appropriate management. Temporal bone imaging is challenging and involves thorough understanding of the anatomy, especially in relation to HRCT imaging. Most of the middle ear pathologies appear as "soft tissue" on imaging. Careful analysis of the soft tissue on the HRCT is crucial in achieving the right diagnosis; clinical information is essential and the imaging findings need correlation with clinical presentation and otoscopic findings. The purpose of this pictorial essay is to enlist the pathologies that present as soft tissue in middle ear and to provide a structured and practical imaging approach that will serve as a guide for confident reporting in daily practice.