• Marc Garetier, Jean Rousset, Ernesto Pearson, Valentin Tissot, Jean-Christophe Gentric, Emmanuel Nowak, Jean-Christophe Ferre, Serge Timsit, and Douraied Ben Salem.
• Department of Radiology, Teaching Military Hospital Clermont-Tonnerre, Brest, France Department of Neuroradiology, University Hospital La Cavale Blanche, Brest, France marc.garetier@wanadoo.fr.
• Acta Radiol. 2014 Dec 1;55(10):1245-52.

BackgroundExcluding a cerebral venous thrombosis (CVT) through imaging is a frequent request in the emergency setting. This assessment often starts by an unenhanced brain computed tomography (CT).PurposeRe-evaluate the value of spontaneous hyperdensity of CVT on helical unenhanced brain CT.MethodsMulticentric retrospective study on CVT probability based on visual assessment of spontaneous hyperdensity of cerebral venous system, performed by four blinded radiologists, individually then collectively, on a population including 14 helical unenhanced brain CTs with CVT and 102 unenhanced brain CTs without CVT (all confirmed by CT or magnetic resonance [MR] venography). Exclusion criteria: no DICOM image, symptoms >15 days, CVT indirect signs on unenhanced CT. A fifth radiologist set 768 regions of interest to measure and to compare the density within the normal venous sinuses and the CVTs.ResultsAfter consensus reading, sensitivity of this sign for CVT diagnosis was 100%, specificity 95.1%, and negative predictive value (NPV) 100%, with high individual NPV (99-100%). Area under the receiver-operating characteristic curve was 0.992 after consensus (0.976-0.986 individually). The spontaneous density was significantly different (P <0.05) between normal sinuses and CVTs, with a density >70 HU reported only within the CVTs, except for the horizontal part of the superior sagittal sinus (hSSS).ConclusionThe dense triangle sign on helical unenhanced brain CT has an excellent NPV to exclude a sinus thrombosis during the first 2 weeks. However, we believe that visual assessment of spontaneous hyperdensity is not sufficient for the diagnosis of CVT, with possible false-positive of the hSSS on unenhanced CT.© The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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