Diagnosis Of Non-acute Cerebral Venous Thrombosis With 3D-CUBE T1-Weighted Sequence

Objective To evaluate the value of 3D-CUBE T1 magnetic resonance sequence(MRI)in the diagnosis of non-acute cerebral venous thrombosis(CVT)by combining routine magnetic resonance imaging and high resolution vessel wall imaging 3D-CUBE T1 sequence in cerebral venous system and CVT.Methods We prospectively included 39 consecutive patients who were clinically suspected as CVT by neurology department in Shandong Qianfoshan Hospital from March 2016 to January 2018,all of the patients with clinical symptoms suspected of CVT during admission.Cerebral routine MRI scans were firstly performed,such as imaging examinations of MRI plain scan,magnetic resonance venography(MRV),susceptibility weighted imaging(SWI).Then 3D-CUBE T1 sequence was performed.With referential diagnostic criteria of CVT diagnosis based on the combination of all of the conventional imaging examinations(including MRI plain scan,MRV and SWI),clinical laboratory examinations and clinical manifestations,evaluated true positive,true negative,false positive and false negative cases of 3D-CUBE T1 sequence as well as MRV alone on patients and segments level,and calculated their sensitivity,specificity,positive predictive value,negative predictive value,the area under the ROC curve and Kappa value.The following 12 venous segments were evaluated for per patient: superior sagittal sinus,inferior sagittal sinus,left transverse sinus,right transverse sinus,left sigmoid sinus,right sigmoid sinus,straight sinus,sinus confluens,basal veins,vein of Galen,right cortical veins,and left cortical veins.The CVT was regarded as acute when the duration of symptoms before imaging was ≤3 days,subacute when it was 4-14 days,and chronic when it was ≥15 days,with subacute and chronic considered as non-acute.Results Among the 39 patients who were clinically diagnosed as suspicious CVT,1 patient had MRI contraindications because of metal implants,and the rest 38 patients underwent cerebral routine MRI scans and 3D-CUBE T1 magnetic resonance sequence scan.3 patients were not included in the CVT diagnosis due to the heavy motion artifacts of the MRI image movements.The final evaluations was performed on 35 patients with suspicious CVT,with a total of 420 venous vascular segments.19 cases were diagnosed as CVT,with 71 positive segments on venous vascular segments level by MRV.There were 17 cases of positive patients with CVT by the combination of conventional imaging tests,with 56 segments on venous vascular segments level.There were 18 cases of positive patients with CVT on all of 35 patients by 3D-CUBE T1 sequence,with 61 positive segments on venous vascular segments level.The accuracy of CVT results of 3D-CUBE T1 sequence or MRV was evaluated by using the positive results of combination of all the conventional MRI imagings as the reference standard.At the patients level,3D-CUBE T1 sequence was diagnosed as a true positive 17 cases of CVT,17 cases of true negative,1 case of false positive and 0 case of false negative.The sensitivity and specificity were 100% and 94.4% respectively,the positive predictive value and the negative predictive value were 94.4% and 100% respectively,and the area under the ROC curve was 0.97.At the segments level,3D-CUBE T1 sequence was diagnosed as a true positive 55 segments of CVT,358 segments of true negative,6 segments of false positive and 1 segment of false negative.The sensitivity and specificity were 98.2% and 98.4% respectively,the positive predictive value and the negative predictive value were 90.1% and 99.7% respectively,and the area under the ROC curve was 0.98.The consistency coefficient Kappa value between 3D-CUBE T1 and the reference diagnosis was 0.943 on the patients level and 0.931 on the segments level.At the patients level,MRV was diagnosed as a true positive 16 cases of CVT,15 cases of true negative.The sensitivity and specificity were 94.1% and 83.8% respectively,the positive predictive value and the negative predictive value were 84.2% and 93.8% respectively,and the area under the ROC curve was 0.89.At the segments level,MRV was diagnosed as a true positive 48 segments of CVT,341 segments of true negative.The sensitivity and specificity were 85.7% and 93.7% respectively,the positive predictive value and the negative predictive value were 67.6% and 97.7% respectively,and the area under the ROC curve was 0.90.Conclusion High resolution vessel wall imaging 3D-CUBE T1 sequence has high sensitivity and specificity comparing to conventional imaging tests,with excellent accuracy,providing reliable diagnostic information for clinical diagnosis and treatments of CVT as well as excellent clinical value.