CT VENOGRAM BRAIN

INDICATIONS

INDICATIONS (1-5)

Known or suspected cerebral venous thrombosis
Investigation of preoperative anatomy - particularly, posterior fossa surgery to assess sigmoid sinus compression
Venous vascular malformations e.g. AVM
Sinus stenosis or occlusion secondary to tumour
Papilledema on ophthalmoscopy
Suspicion of idiopathic intracranial hypertension (IIH) / elevated CSF opening pressure

Pathology Demonstrated

Dural venous sinus thrombosis
Thrombosis re-canalisation
Sinus stenosis or occlusion secondary to tumour invasion (e.g. meningioma)
Venous vascular malformations e.g. AVM
Idiopathic intracranial hypertension
Anatomical variants such as sinus hypoplasia and aplasia, arachnoid granulations, sinus duplication or fenestration

Patient Preparation

Patient able to lie still for ten minutes
Not claustrophobic (sedation may be given)
Cognitively capable of following basic instructions
Metal artefacts removed from the region of interest
No respiratory distress when lying supine
Not allergic to Iodine based Contrast
No known kidney disease (EGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function
No hyperthyroidism, may induce thyroid storm
Patient to have 18G cannula in anterior cubital fossa to allow a 7ml/s flow rate (20G cannula acceptable if flushing to 5ml/s)
Preferably patient fasted for 4 hours

Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head
Radiopaedia. CT Cerebral Venography technique. [Internet]. 2016. [updated 19 Sep 2021, accessed 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-cerebral-venography-technique
American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria
Johns Hopkins Medicine. Venogram. [Internet]. 2021. [updated 2021, cited on 23 Nov 2021]. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/venogram
Radiology Assistant. Cerebral Venous Sinus Thrombosis. [Internet]. 2010. [updated 21 Oct 2010, cited 3 Jan 2022]. Available from https://radiologyassistant.nl/neuroradiology/sinus-thrombosis/cerebral-venous-thrombosis
Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012.

ANATOMYINCLUDED