A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis

Abstract

Abstract Background: The current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. Methods: We consecutively included eligible patients, with a first-time diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV), in this retrospective study from January 2019 through December 2021. A comprehensive CVST-Score was established according to magnetic resonance black blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess its potential to monitor ICP noninvasively. Results: A total of 87 patients were included into the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP＜250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP＞330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, CVST-Scores were linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and ＞330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). Conclusions: A simple and noninvasive CVST-Score could be employed to rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. It can be used to evaluate therapeutic responses and avoid unnecessary invasive procedures at long-term follow-up.