Work

Perfusion imaging abnormalities in acute cerebral venous sinus thrombosis: A case series

Year: 2026

Type: article

Abstract: The clinical value of perfusion imaging in arterial ischemic stroke is well established, but its interpretation in cerebral venous sinus thrombosis (CVST) remains less clearly defined. We present a case series of five patients with acute CVST who demonstrated perfusion abnormalities on initial CT perfusion (CTP) or MR perfusion (MRP). The observed findings demonstrated a spectrum of venous hemodynamic patterns. Several patients showed delayed transit metrics, including increased MTT or Tmax, with preserved or increased CBV, suggesting venous congestion or vasogenic edema rather than arterial-type ischemic penumbra. In contrast, one patient demonstrated delayed transit with decreased CBV and CBF, suggesting more advanced venous infarction or tissue-level perfusion failure. One additional patient demonstrated hyperperfusion in a non-territorial distribution, most compatible with ictal or peri-ictal hyperemia rather than a primary venous congestion pattern. Four patients had favorable neurological recovery, whereas one patient had a poor short-term outcome likely driven primarily by large baseline hemorrhage. These cases highlight that perfusion abnormalities in CVST should be interpreted differently from arterial stroke and may be most useful when stratified into venous congestion, venous infarction, and seizure-related hyperperfusion patterns.

Source: The Neuroradiology Journal

DOI: 10.1177/19714009261460767

Authors: Derek Tsang, Andrew Cho, Karthik Lalwani, Vivek Yedavalli

Institutions: Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital

Language: English

Topic: Cerebral Venous Sinus Thrombosis

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,150