TRIBUTARY VENOSINUS OCCLUSION AND SEPTIC CAVERNOUS SINUS THROMBOSIS -CT AND MR FINDINGS

PURPOSE: In autopsy reports of patients who died of septic cavernous s inus thrombosis, tributary venosinus occlusion has been a common findi ng related to intracranial inflammatory complications, The purpose of this article is to illustrate the MR and CT appearance of septic caver nous sinus thrombosis and tributary venous occlusion, METHODS: Over a period of 7 years, eight patients with septic cavernous sinus thrombos is were examined by contrast-enhanced thin-section CT. The CT scans of these eight patients and those of 30 healthy control subjects were as sessed independently and subjectively by two blinded readers to ascert ain the presence, size, and density of areas of nonopacification withi n the cavernous sinus and the presence of filling defects and dilation of tributary veins and venous sinuses. In six subjects, MR images sup plemented by a contrast-enhanced spoiled gradient-recalled acquisition in the steady state (SPGR) sequence were assessed with respect to the presence of filling defects, expansion, and signal abnormalities with in the cavernous sinus and tributary veins and sinuses. The MR and CT findings were compared. RESULTS: The CT studies of the eight patients were consistently differentiated from those of the control subjects by the two readers. Contrast-enhanced CT findings in patients included a reas of nonopacification that were present within the cavernous sinus bilaterally in six cases and unilaterally in two. The size of the fill ing defects exceeded 7 mm in 76% of thrombosed cavernous sinuses compa red with 9% of control subjects. The mean density of filling defects i n patients differed significantly from those in control subjects, Comp arison of the MR and CT findings in six cases showed the contrast-enha nced SPGR sequence to be equivalent to CT with respect to delineation of filling defects. CONCLUSION: Contrast-enhanced high-resolution CT f indings indicate that venosinus thrombosis associated with septic cave rnous sinus thrombosis is not restricted to the superior ophthalmic ve in and is more common than previously assumed. A contrast-enhanced SPG R MR sequence may be used as a reliable alternative to establish the d iagnosis of cavernous sinus and tributary venosinus thrombosis.