Magnetic resonance thrombus imaging for the differentiation of chronic versus (sub)acute cerebral vein thrombosis: A case report

The diagnosis of cerebral vein thrombosis (CVT) can be difficult. Patients with suspected CVT, in whom venous sinuses are affected by intracranial tumours or after intracranial surgery constitutes a particular challenging setting. Magnetic resonance non-contrast thrombus imaging (MR-NCTI) is a new magnetic resonance imaging (MRI) technique that has previously been shown to be accurate in the diagnosis of a first CVT and difficult-to-diagnose venous thrombosis in other anatomical locations. In this case report, a patient with a medical history of craniotomy for parieto-occipital meningioma was suspected of an acute CVT, but had an inconclusive computed tomography (CT) and MRI venography. MR-NCTI showed no abnormalities diagnostic for (sub)acute CVT and thus cerebral sinus occlusion was most likely a chronic thrombus or a result of residual meningioma tissue. Anticoagulant treatment was discontinued and she was discharged from hospital in good health. This case shows that MR-NCTI may be a valuable additional imaging test in complex cases in whom CT and MRI venography could not exclude acute CVT. •The diagnosis of cerebral vein thrombosis (CVT) can be challenging.•Magnetic resonance non-contrast thrombus imaging (MR-NCTI) can differentiate acute from chronic thrombosis.•MR-NCTI was used to exclude (sub)acute CVT in a patient with an inconclusive CT and MRI venography.•MR-NCTI may be of value in the diagnostic management of complex cases with suspected CVT and may avoid overdiagnosis.