CVT Type - Imaging Analysis

Type of CVT: Left Transverse and Sigmoid Sinus Thrombosis (Dural Venous Sinus Thrombosis - Lateral Sinus Type)

Key Imaging Findings

• The right transverse sinus and right sigmoid sinus show robust, continuous, bright flow signals - indicating normal patency
• The left transverse sinus and left sigmoid sinus show complete absence of flow signal - this non-visualization is the hallmark of thrombosis
• The superior sagittal sinus appears patent (no evidence of SSS thrombosis)

• The normal flow void (pitch-black signal of flowing blood) is lost in the left transverse sinus
• Replaced by abnormal hyperintense/isointense signal - this represents the actual thrombus filling the sinus
• No obvious bilateral parasagittal venous infarcts (argues against dominant SSS thrombosis)
• No bilateral thalamic swelling (argues against deep venous thrombosis)
• No large territorial venous hemorrhagic infarcts visible

Classification Summary

MRI Brain with MRV - Radiological Impression

FINDINGS

• Cerebral cortex and subcortical white matter show normal signal intensity on T1W and T2W sequences
• No focal areas of T2/FLAIR hyperintensity to suggest demyelination, vasogenic edema, or ischemic changes
• Gray-white matter differentiation is preserved
• No restricted diffusion on DWI/ADC - no evidence of acute cytotoxic edema or acute ischemic infarction

• Caudate nuclei, lentiform nuclei (putamen and globus pallidus), and thalami are symmetric and show normal signal intensity
• No focal lesions or signal abnormalities

• Lateral ventricles, 3rd ventricle, and 4th ventricle are normal in size and configuration
• No ventriculomegaly or hydrocephalus
• Basal cisterns are patent
• Cerebral sulci and Sylvian fissures are normal for age - no sulcal effacement

• Midline is central with no shift
• Corpus callosum is intact and morphologically normal
• No evidence of subfalcine, transtentorial, or tonsillar herniation

• Cerebellar hemispheres and vermis show normal foliation and signal intensity
• Brainstem (midbrain, pons, medulla) is normal in morphology and signal
• Cerebellopontine angles are clear

• No subdural or epidural hematoma/fluid collection
• No extra-axial mass lesions

• Visualized paranasal sinuses and mastoid air cells appear clear
• Orbits grossly unremarkable

• Superior sagittal sinus: Patent with normal continuous flow signal
• Straight sinus and vein of Galen: Patent
• Right transverse sinus and right sigmoid sinus: Normal, robust flow signal
• Left transverse sinus and left sigmoid sinus: Markedly reduced / absent flow signal - complete non-visualization consistent with thrombosis
• Deep venous system (internal cerebral veins): Patent

IMPRESSION

1. Left transverse and sigmoid sinus thrombosis - complete absence of flow signal in the left lateral sinus pathway on MRV, with corresponding loss of normal flow void on structural sequences, consistent with dural venous sinus thrombosis (CVST)
2. No parenchymal venous infarction - no hemorrhagic or ischemic parenchymal changes identified at this time
3. No acute intracranial hemorrhage
4. No space-occupying lesion, mass effect, or midline shift
5. No hydrocephalus
6. Normal brain parenchyma - cerebrum, cerebellum, and brainstem are unremarkable