From an imaging standpoint, the most important risk factor for traumatic venous injury is a skull fracture (or less commonly a penetrating foreign body) that involves a dural venous sinus or jugular bulb/foramen. In a retrospective study of 195 patients with closed head trauma who received multidetector-row CTV, acute traumatic venous sinus thrombosis was seen only in those patients with fractures extending to a dural sinus or jugular bulb (41% rate of thrombosis), and hemorrhagic venous infarctions were seen only in the setting of occlusive dural venous sinus thrombosis (55% of all thromboses) [62]. Another retrospective study of 472 patients with closed head trauma with skull fracture crossing a dural venous sinus also identified a high incidence of small epidural hemorrhages (81%), which can be compressive and misdiagnosed as venous sinus thrombosis [61]. Direct observation of hyperattenuating thrombus within a dural venous sinus on a noncontrast CT should prompt further evaluation; however, this is present in only one-third of venous sinus thrombosis. Indirect evidence of dural sinus thrombosis includes venous infarcts (subcortical edema), one-third of which develop parenchymal hemorrhage [30]. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the imaging evaluation of suspected intracranial venous injury. CT Head Please refer to CTV for neurovascular imaging evaluation of suspected intracranial venous injury. Concurrent CT may be useful in the clinical setting of suspected intracranial venous injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). Concurrent head CT is also useful in the initial imaging evaluation of head trauma when there is no prior imaging. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the imaging evaluation of suspected intracranial venous injury.
Head Trauma PCAs. From an imaging standpoint, the most important risk factor for traumatic venous injury is a skull fracture (or less commonly a penetrating foreign body) that involves a dural venous sinus or jugular bulb/foramen. In a retrospective study of 195 patients with closed head trauma who received multidetector-row CTV, acute traumatic venous sinus thrombosis was seen only in those patients with fractures extending to a dural sinus or jugular bulb (41% rate of thrombosis), and hemorrhagic venous infarctions were seen only in the setting of occlusive dural venous sinus thrombosis (55% of all thromboses) [62]. Another retrospective study of 472 patients with closed head trauma with skull fracture crossing a dural venous sinus also identified a high incidence of small epidural hemorrhages (81%), which can be compressive and misdiagnosed as venous sinus thrombosis [61]. Direct observation of hyperattenuating thrombus within a dural venous sinus on a noncontrast CT should prompt further evaluation; however, this is present in only one-third of venous sinus thrombosis. Indirect evidence of dural sinus thrombosis includes venous infarcts (subcortical edema), one-third of which develop parenchymal hemorrhage [30]. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the imaging evaluation of suspected intracranial venous injury. CT Head Please refer to CTV for neurovascular imaging evaluation of suspected intracranial venous injury. Concurrent CT may be useful in the clinical setting of suspected intracranial venous injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). Concurrent head CT is also useful in the initial imaging evaluation of head trauma when there is no prior imaging. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the imaging evaluation of suspected intracranial venous injury.