Background: Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific\nsymptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT)\nin patients with nontraumatic headache and clinically suspected CVST.\nMethods: A retrospective consecutive series of patients referred 2013â??2015 for radiology were evaluated. Eligible\npatients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography\n(CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All\nCTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT\n(2017â??2019).\nResults: Less than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining\n99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the\npatient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of\nCVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65)\nvenous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion\nwritten in referral, 10%).\nConclusions: Despite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon.\nEvaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems\nreasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading\nneCT for other indications.
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