Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study

August Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study De-Sheng Zhu 0 1 Jue Fu 0 1 Yi Zhang 0 1 Chong Xie 0 1 Xiao-Qing Wang 0 1 Yue Zhang 0 1 Jie Yang 0 1 Shi-Xu Li 0 1 Xiao-Bei Liu 0 1 Zhi-Wen Wan 0 1 Qiang Dong 0 1 Yang-Tai Guan 0 1 0 1 Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China , 2 Department of Neurology, Huashan Hospital, Fudan University , Shanghai , China , 3 Department of Pathology, Fuzhou Medical College, Nanchang University , Fuzhou , China , 4 Department of Neurology, Changhai Hospital, Second Military Medical University , Shanghai , China , 5 Department of Neurology, Nanyuan Hospital , Beijing , China , 6 Department of Neurology, Dong Fang Hospital, School of medicine, Tong Ji University , Shanghai , China 1 Editor: Tian-wu Chen, Affiliated Hospital of North Sichuan Medical College , CHINA - Funding: This study was supported by the Natural Science Foundation of China (No. 81230027), the Postdoctoral Science Foundation of China (No. 2014M560297), the Science and Technology Foundation of Shanghai (No. 14140903300), the Science and Technology Foundation of Jiangxi (No. 20112015), the Municipal Commission of Health and Family Planning Foundation of Shanghai (No. 201440347, 20144Y0225), and the Natural Science Foundation of Shanghai (No.14ZR1436700). Transverse sinus stenosis (TSS) is common among patients with cerebral venous sinus thrombosis. No previous studies have reported on double-track sign detected on axial Gdenhanced T1WI in TSS. This study aimed to determine the sensitivity and specificity of the double-track sign in the detection of TSS. We retrospectively reviewed medical records of 383 patients with transverse sinus thrombosis (TST) and 30 patients with normal transverse sinus from 5 participating hospitals in china from January 2008 to June 2014. 167 feasible transverse sinuses included in this study were categorized into TSS (n = 76), transverse sinus occlusion (TSO) (n = 52) and transverse sinus normal (TSN) groups (n = 39) according to imaging diagnosis on digital subtraction angiography (DSA) or magnetic resonance venography (MRV). Double-track sign on axial Gd-enhanced T1WI was compared among the three groups. Sensitivity and specificity of double-track sign in detection of TSS were calculated, with final imaging diagnosis of TSS on DSA or MRV as the reference standard. Of 383 patients with TST recruited over a 6.5-year period, 128 patients were enrolled in the study, 255 patients were excluded because of insufficient clinical data, imaging finding and delay time, and 30 matched patients with normal transverse sinus were enrolled in the control group. Therefore, double-track sign assessment was conducted in 167 available transverse sinuses of 158 patients. Of the 76 sinuses in TSS group, 51 had double-track sign. Of the other 91 sinuses in TSO and TSN groups, 3 had a false-positive double-track sign. Competing Interests: The authors have declared that no competing interests exist. Thus, double-track sign on axial Gd-enhanced T1WI was 67.1% (95% CI 55.3–77.2) sensitive and 96.7% (95% CI 89.9–99.1) specific for detection of TSS. The double-track sign on axial Gd-enhanced T1WI is highly specific and moderate sensitive for detection of TSS. Nevertheless, it could be a direct sign and might provide an early clue for TSS. Transverse sinus stenosis (TSS) is a common subtype of cerebral venous sinus thrombosis (CVST) that affects the dural venous sinus, and it accounts for about 40% of all CVST [1]. TSS contributes to intracranial hypertension and leads to severe clinical symptoms [2]. Patients with headache [3], blurred vision [4], seizure, cognitive disorder and isolated intracranial hypertension syndrome are often referred to neurologists to rule out dural venous sinus and cerebral vein causes [5, 6]. Misdiagnosis of TSS is common because of the underlying risk factors and the varied clinical manifestations [7]. Though digital subtraction angiography (DSA) is considered to be the gold standard of dural sinus stenosis, the AHA/ASA 2011 Scientific Statement recommends magnetic resonance imaging (MRI) with magnetic resonance venography (MRV) as the imaging test of choice for evaluation of suspected stenosis [8]. In most institutions, MRI is still the first-line feasible imaging method in the emergency department setting, but conventional unenhanced T1 weighted image (T1WI) MRI has a low accuracy for thrombosis, and stenosis could be exaggerated on MRV because of its potential diagnostic pitfalls related with frequent blood flowrelated artifacts [9]. Currently, we frequently observed the abnormal region showed a double-track pattern on gadolinium (Gd)-enhanced T1WI in patients with TSS. We firstly named it “double-track sign”, which was caused by the contrast agent in the affected dural sinus wall, presenting with two hyperintense (...truncated)