BACKGROUND Clinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT) in patients with nontraumatic headache and clinically suspected CVST. METHODS A retrospective consecutive series of patients referred 2013-2015 for radiology were evaluated. Eligible patients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography (CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All CTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT (2017-2019). RESULTS Less than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining 99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the patient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of CVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65) venous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion written in referral, 10%). CONCLUSIONS Despite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon. Evaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems reasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading neCT for other indications.

中文翻译：

---

对临床怀疑患有非创伤性头痛的脑静脉窦血栓形成的患者进行放射学评估-一项回顾性观察性研究，包括一个验证队列。

背景技术由于诸如头痛之类的非特异性症状，对脑静脉窦血栓形成（CVST）的临床怀疑并不确切。目的是回顾性评估非增强CT（neCT）对非创伤性头痛和临床疑似CVST患者的诊断价值。方法回顾性回顾性分析了2013-2015年接受放射学检查的连续患者。符合条件的患者具有非创伤性头痛，并在转诊中怀疑患有CVST，并通过CT静脉造影（CTV）和非增强CT（neCT）进行了调查。重新评估neCT扫描是否存在CVST或其他病理。检查所有CTV中是否存在CVST。验证队列包括10例非创伤性CVT患者（2017-2019年）。结果后来的CTV证实，不到1％（1/104）的neCT有可疑血栓。其余的99％拥有CTV（不包括CVST）。11％的患者有其他影像学发现可解释其症状。在CVST患者中，血栓形成的硬膜窦高度减弱（最大HU 89），导致怀疑CTV证实为CVST。验证队列（n = 10）证实了在10天之内出现的所有患者中均存在已确认的血栓，并且存在高度减毒（HU> 65）静脉结构（怀疑是转诊患者，占10％）。结论尽管有临床怀疑，但非创伤性头痛中CVST的影像学表现并不常见。在某些情况下，评估neCT对硬脑膜窦的高衰减，然后进行CTV确认是合理的。CVST应该得到所有放射科医生的认可，并且在阅读neCT的其他适应症时需要很高的意识。