Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a scarce disease with poor prognosis and its diagnosis often challenges physicians due to nonspecific symptoms and widespread clinical manifestations. AIM: To investigate the findings of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of patients with CVST diagnosis in Ali Ebne Abitaleb Hospital in Zahedan during 2013–2016 and to evaluate imaging pitfalls involving in late diagnosis, complications, and even death. METHODS: This retrospective descriptive study was done on 57 patients with confirmed CVST during 2013–2016 in Ali Ebne Abitaleb Hospital in Southeast of Iran (Zahedan). The MRI and MRV findings and related diagnostic pitfalls were evaluated. Twenty-one patients are pediatrics and 33 patients are adults. RESULTS: Of 57 patients, evidences of cerebral edema were found in 33 patients, among whom 2 patients showed parenchymal edema (cerebral edema) without infarction, and 31 patients exhibited parenchymal edema with infarction. The frequency of involvement in descending order was as followed; transverse sinus (96.49%), sigmoid sinus (49.12%), superior sagittal sinus (29.82%), jugular vein (19.29%), internal cerebral veins (7.01%), straight sinus (5.2%), and cortical veins (5.2%). Diagnostic pitfalls were also found in 8 patients. Seven patients exhibited acute and subacute thrombosis mimicked normal sinus flow void in T2-weighted images. No filling defect was seen on gadolinium-enhanced T1-weighted image in the other patient due to the sub-acute phase of thrombosis. CONCLUSION: The delayed diagnosis of CVST originating from nonspecific clinical features and diagnostic imaging pitfalls can result in poor outcomes in patients. To prevent the diagnostic pitfalls, the clinician should give a brief history and clinical data and radiologist(s) should interpret the findings in addition to the use of advanced MR sequences.