ROLE OF NON-ENHANCED BRAIN CT IN DIAGNOSIS OF CEREBRAL VENOUS SINUSES THROMBOSIS WITH THE CORRELATION OF POTENTIAL PREDICTIVE LABORATORY TESTS

Introduction: Non-enhanced computed tomography (NCCT) is the first "preliminary" neuroimaging test. It is a rapid examination that aids the radiologist in identifying the defect area and the clinician in decision-making about treatment. Cerebral Venous Sinus Thrombosis (CVT) may be suspected if there is an apparent hyperattenuating of the venous sinus.

Objectives: Measurements of the radio density area using Hounsfield Units readings of the NCCT were taken from patients with and without a cerebral venous sinus thrombus as confirmed by CT venography, as well as determining laboratory predictors such as Hematocrit (HCT), Blood Urea Nitrogen (BUN), and creatinine (Cr) for an accurate and effective diagnosis of CVT.

Methodology: A retrospective case-control study of patients who presented with acute neurologic symptoms to the emergency department at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia, from May 2016 to April 2021 was included in this study. A total of 200 patients participated in this study.

The study included 99 CVT patients and 101 control patients aged 14 to 80 years with newly onset neurological symptoms, confirmed venous sinus thrombosis by CT Venogram, and NCCT at presentation. Attenuation of venous sinuses was measured by technologists and radiologists. A region of interest (ROI) measuring 1-2 mm (based on sinus size) was used to measure the attenuation of the Dural sinuses.

To analyze the data, we used IBM SPSS Statistics for Windows by IBM Corp. Descriptive statistics are used to explore the relationship between NCCT brain and laboratory data (BUN, HCT, and Cr) to assess the incapacitated CVT.

Main Result: As a result, CVT was observed in 77 (77.8%) of the females and 22 (22.2%) of the males. The median age of CVT patients was 40.7 years, while the median age of controls was 35.9 years. Gender and age differences were significant, with a p-value for the age 0.023 and p-value for gender 1. Headache was the most frequently reported symptom in clinical presentations, accounting for 47.5% of the total. Furthermore, the highest risk factor was oral contraceptives with 5.1%. In our study, we found among patients. The superior sagittal sinus represents the most defective area of CVT (21.9%). An independent t-test was used to compare the differences in CT attenuation between the control group and the CVT group at the sites of thrombus in each sinus. The optimal cut-off attenuation value for Dural sinuses was 62 HU, with a sensitivity of 66.82%, specificity of 89.45 %.

Conclusion:Hounsfield units' values can be affected by different factors such as the location of the thrombosis, the hydration status of the patient, and coagulopathy. The HU Opportunity Measurements of suspected cerebral venous sinus provide radiologists with an additional tool for increasing reporting confidence of the relatively rare clinical start of CVT, guiding further imaging and management.