Comparative evaluation of contrast-enhanced and time-of-flight MR venography in cerebral venous sinus thrombosis

Background and objectives Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially life-threatening condition that can result in significant morbidity. Early and accurate diagnosis is essential for timely and appropriate treatment. While 2D time-of-flight (TOF) MR venography is commonly used, contrast-enhanced MR venography (CE-MRV) is often considered more accurate. This study aimed to compare the diagnostic accuracy of 2D TOF MRV and CE-MRV in detecting CVST. Materials and methods. This hospital-based ambispective study was conducted at Saveetha Medical College and Hospital, Chennai, between January 2021 and June 2022. A total of 30 patients, identified retrospectively or prospectively as clinically suspected CVST cases, were included. All patients underwent MRI and MRV using both 2D TOF and CE-MRV sequences. Sensitivity and specificity were calculated for each modality, and parenchymal changes were assessed. Results. Of the 30 patients, the majority were female (73.3%). Seizures were the most common presenting symptom (76.7%), followed by headache (73%). Superior sagittal sinus thrombosis was observed in 86% of cases. The sensitivity of 2D TOF MRV in detecting superior sagittal sinus thrombosis was 92.31%, while the sensitivity for lateral and straight sinus thrombosis was 79.17% and 100%. Conclusion. CE-MRV identified superior sagittal sinus thrombosis in 26 patients. 2D TOF MRV demonstrated a sensitivity of 92.3% and a specificity of 50% for superior sagittal sinus thrombosis, using CE-MRV as the reference standard. CE-MRV provided improved visualization of complex venous anatomy, supporting its role in accurate CVST diagnosis.