Diagnostic Value of Non‐Enhanced Brain Computed Tomography Scan in the Evaluation of the Cerebral Venous Sinus Thrombosis: A Report From East of Iran

ABSTRACT Background Cerebral venous sinus thrombosis (CVST) is a rare condition with significant morbidity and mortality. Given its low prevalence yet high mortality rate, timely diagnosis is crucial. Non‐enhanced computed tomography (CT) of the brain is often the initial imaging modality employed in neurological emergencies. This study aims to evaluate the diagnostic efficacy of non‐enhanced CT in identifying acute CVST. Methods The present retrospective observational study was conducted on patients admitted to the medical centers affiliated with the Birjand University of Medical Sciences, Birjand, Iran from 2016 to 2024. Forty confirmed cases of acute CVST were sex‐ and age‐matched with 40 subjects who did not have the condition. Demographic and clinical data, mean venous sinus attenuation, Hounsfield to hematocrit ratio, basilar artery density, veno‐basilar attenuation ratio, and veno‐basilar attenuation difference were measured. Results The mean age was 40.75 ± 16.44 and 41.2 ± 17.04 years for the case and control groups, respectively ( p = 0.26). Most patients referred to the medical center with presentation of headache (30 (75%) of cases and 10 (25%) of control individuals) ( p < 0.001). By considering the optimal cut‐off of the mean density of venous sinuses as 48.03 HU, its sensitivity and specificity represent 80% and 85%, respectively. Both the VB ratio and VB differences at their optimal cut‐off of 1.34 and 12.36 revealed the sensitivity and specificity of 75% and 72.5%, respectively. Furthermore, the H:H ratio at 1.22 as an optimal level demonstrated 70% sensitivity and 65% specificity. Conclusion Incorporating measurements of venous sinus and basilar artery attenuation, along with the calculation of the veno‐basilar ratio and difference, may enhance the diagnosis of acute CVST using non‐enhanced brain CT scans.