FROM SIGNAL TO SIGNIFICANCE: ROLE OF DWI AS A DIAGNOSTIC MARKER IN CEREBRAL VENOUS THROMBOSIS

Introduction: Cerebral venous thrombosis (CVT), a distinct and under-recognized cause of stroke, results from thrombosis of the dural sinuses or cortical veins. Unlike arterial strokes, CVT involves a combination of cytotoxic and vasogenic edema due to venous congestion. Diffusionweighted imaging (DWI), an advanced MRI technique, can differentiate these edema types, offering diagnostic and prognostic value. This study evaluates DWI's role in detecting parenchymal abnormalities and characterizing edema in patients with CVT. Materials and Methods: This prospective observational study included 40 patients clinically suspected of CVT, conducted from January 2024 to February 2025 at a tertiary care hospital. MRI scans were performed on a 1.5 Tesla Siemens Sempra scanner, incorporating conventional sequences, DWI, and MR venography. ADC values were calculated by placing regions of interest on abnormal parenchymal areas, avoiding hematomas. The nal diagnosis was conrmed using MR venography and structural MRI. Results: Among 40 patients (mean age: 30.65 years), headache was the most common symptom (80%), with superior sagittal sinus being the most frequently thrombosed site (55.5%). DWI revealed three main patterns: heterogeneous signal in hemorrhagic infarcts, hyperintense signal in non-hemorrhagic infarcts, and high-signal intravascular clots. ADC values varied: cytotoxic edema showed decreased ADC, while vasogenic edema exhibited elevated values. All parenchymal lesions were supratentorial and were also visible on conventional MRI, suggesting limited added value of DWI for clot detection. Conclusion: DWI enhances the diagnostic utility of conventional MRI in CVT by characterizing parenchymal changes and distinguishing cytotoxic from vasogenic edema, aiding prognosis and treatment planning. Although DWI has limited utility in detecting thrombus directly, it offers essential insights into the underlying pathophysiology and potential reversibility of venous infarcts. Future time-sensitive studies could further elucidate DWI's prognostic value in CVT management