To describe imaging features of cerebral venous sinus thrombosis (CVST) in CT and MRI, to underline how accurate diagnosis of CVST is crucial and to describe its potential pitfalls.

CVST, first reported by Ribes in 1825, is a particular form of cerebrovascular disease and accounts for 0.5-1% of all cerebrovascular diseases [1]. It affects mostly adults, younger than 50 years old, especially women in childbirth age and children. CVST can be associated with significant morbidity and mortality [2] and an early diagnosis can make an important difference for patients outcome. There are many recognized risk factors and causes for cerebral venous thrombosis: venous thromboembolism, pregnancy, oestrogen therapy/oral contraceptives, thrombophilia, hypercoagulability associated with inflammatory disease,...

Unenhanced CT is often the most common initial imaging technique required by clinician for patients with new onset symptoms. In unhenanced CT there are a few findings that can suggests CVST as the classical “cord-sign”, the cordlike hyperattenuation within a dural sinus, most commonly seen in the transverse sinus, detectable in sinus or veins filled with thrombus as foci of hyperattenuation [5]. Evidence of venous infarcts, with hemorrhagic components and significantly greater oedema than arterial infarction can support diagnostic hypothesis of CVST, especially if infarcts...

The clinical picture of cerebral venous sinus thrombosis is non specific: patients with low clinical suspicion of CVST can be screened with unenhanced CT, adopting further imaging such as CECT, MRI, MRI venography in case of high suspicion. Radiologists need to be aware of the various imaging features of CVST, which can be subtle, because a correct radiological diagnosis can guide appropriate therapy, changing patients outcome and reducing risks of complications and long-term sequelae. Diagnostic pitfalls are potentially associated with all imaging techniques, but can...

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