The role of diffusion weighted imaging in cerebral veinthrombosis

Cerebral venous thrombosis (CVT) is a rare subtype of stroke that can present with a wide range of clinical manifestations and may lead to life-threatening complications. Although digital subtraction angiography (DSA) is considered the gold standard for diagnosis, CVT is most commonly diagnosed today using MRIbased imaging techniques. Among non-invasive modalities, MR venography (MRV) is accepted as the gold standard. Other MRI sequences also contribute significantly to the diagnosis. In our study, we investigated the role of diffusion-weighted imaging (DWI), a widely used and essential sequence in acute neurological conditions, in the diagnosis of CVT. A total of 82 patients who presented to Akdeniz University Hospital between 2014 and 2024 and were diagnosed with CVT—confirmed by MRI sequences and MRV—were included in the study. We evaluated signal changes within cerebral venous thrombi on DWI, as well as their temporal evolution. These signal alterations were assessed in relation to the time from symptom onset to imaging and the timing of follow-up scans after treatment. The findings were also compared with other MRI sequences, primarily T2-weighted images. At the time of diagnosis, DWI (b1000) hyperintensity within the thrombus was observed in 59.8% of the patients, while T2 hyperintensity was noted in 74.4%. In follow-up imaging, DWI findings normalized in 89.3% of patients, whereas T2 hyperintensity resolved in only 36.6%. These results suggest that DWI may aid in early diagnosis and provide insights into thrombus resolution in later stages. However, since T2 hyperintensity persists in a significant proportion of cases on follow-up imaging, it may be more valuable for assessing recanalization. In cases of cortical vein thrombosis, positive findings were seen on DWI in 14 out of 16 patients. This is comparable to T1-weighted images, where hyperintensity was observed in 15 out of 16 patients. In contrast, T2-weighted signal increase was noted in only 4 out of 16 cases. Therefore, DWI appears to have significantly higher sensitivity than T2-weighted imaging for detecting cortical vein thrombosis. DWI may provide substantial diagnostic support, especially in the early phase of cortical vein involvement. Our study also investigated the frequency of hemorrhage or infarction, which are major complications of CVT, and their relationship with patient age and the localization of venous involvement. Across the entire patient population, the rate of hemorrhage or infarction was found to be 37%. There was no statistically significant difference between adult and pediatric age groups in terms of complication rates. However, hemorrhage or infarction was significantly more frequent in patients with cortical vein involvement.