0:01

The option of whether to perform a CT venogram

0:05

versus an MR venogram for a patient for sagittal

0:09

sinus thrombosis or, uh, cortical vein thrombosis

0:13

really depends, in part, on the age of the patient.

0:16

As I've said previously, you generally want to

0:20

prevent radiation to the younger patient group.

0:24

And it's true that with sagittal sinus

0:27

thrombosis and cortical vein thrombosis, it

0:29

occurs more commonly in a pediatric age group

0:32

than in an adult age group, except for certain

0:35

uh, patient populations, such as patients

0:38

who have cancer who are hypercoagulable.

0:40

So, all things being equal,

0:42

in children, recommend MR venography.

0:46

In adults, recommend CT venography.

0:49

Why CT venography? In general, it's because we

0:53

have a higher resolution study with CT venography,

0:56

and it's a faster study from the

0:59

standpoint of the scan times.

1:01

So, this is the same patient as before,

1:04

who we had demonstrated that there

1:06

was cortical vein thrombosis.

1:09

And on the CT venogram, what you see are the veins

1:14

that are not filling well with contrast. They are

1:17

outlined by contrast, and you compare that with the

1:21

density of the contrast-enhancing superior sagittal

1:25

sinus, and you can be very convinced of that.

1:28

If you look at the MIP image, it's a little

1:33

bit more subtle, but this is the thrombosed

1:37

vein right here coming into the sagittal sinus.

1:42

So, thrombosed vein, thrombosed vein

1:47

on the MIP image of the CT venogram.

1:51

Let's look at that on the coronal image.

1:56

And we're looking way up high here.

1:59

I'm going to magnify and pull this down for you.

2:03

So, a little bit of magnification,

2:07

and then bring it down.

2:09

This is the vein that is outlined by

2:16

contrast in the wall, comparing it to the

2:20

superficial vein on the contralateral side.

2:22

So, this is an example of a CT venogram

2:26

showing cortical venous thrombosis.

2:29

And the patient did have—I don't know whether

2:31

you noticed it—the patient did have an area of

2:34

low density corresponding to the venous ischemic

2:38

area on the CT scan, as well as on the MRI scan.

Case: Cortical Vein Thrombosis on CTV

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