AccScience Publishing / BH / Online First / DOI: 10.36922/bh.2756

Assessment of cerebral venous sinus: Anatomical and functional diagnostic performance of three-dimensional reconstruction models based on venous sinus MRI and CT images

Xin Liu1† Zhenxin Hong2† Heyu Ding3† Pengfei Zhao3 Shusheng Gong4 Dhanjoo Ghista5 Zhenchang Wang3*
Show Less
1 Guangdong Academy Research on VR Industry, School of Industrial Design and Ceramic Art, Foshan University, Foshan, Guangdong, China
2 Department of Industrial Robotics, School of Artificial Intelligence, Guangdong Engineering Polytechnic College, Qingcheng, Guangdong, China
3 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
4 Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
5 University 2020 Foundation, San Jose, California, United States of America
Brain & Heart 2024, 2(2), 2756
Submitted: 16 January 2024 | Accepted: 8 April 2024 | Published: 8 May 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Venous sinus stenosis is commonly observed in patients presenting with pulsatile tinnitus (PT). While magnetic resonance imaging (MRI) and computed tomography (CT) are commonly used for assessing venous sinus geometries, the preferred modality remains unclear. In this study, we reconstructed the three-dimensional (3D) geometries of the venous sinus using MRI and CT imaging data from 20 PT patients. We conducted comparisons of the anatomical features of the venous sinus through case-wise analysis and anatomic geometrical parameter-wise analysis. Our findings indicate that by taking the geometries from CT as a reference, MRI could provide a better illustration of venous structure, primarily due to a stronger flow signal concentrated in the vascular tree. We observed high agreements in anatomic parameters measured from 3D geometries reconstructed based on CT and MRI in 19 out of 20 cases. Notably, the cross-sectional area of the sinus and segment length displayed the highest consistency, with a mean difference of -5.01% and 6.5% between modalities, respectively. In addition, we noticed that 55% of cases exhibited consistency in analyzing the confluence of the sinus, while variants of connectivity and collateral branching were observed between CT and MRI. Importantly, CT-based geometric reconstruction provided better detail of inflow side branches in the straight sinus, whereas MRI preserved more side branches of outflow in the downstream sinus. It is important to note that CT-based evaluation may be affected by the bone structures surrounding the venous sinus, whereas MRI-based evaluation focuses on blood flow to the segments, potentially indicating both anatomical and functional abnormalities.

Cerebral venous sinus
Pulsatile tinnitus (PT)
Magnetic resonance imaging (MRI)
Computed tomography
This study is supported by the National Natural Science Foundation of China (grant nos.: 82202098, 61931013, and 82001910) and the Natural Science Foundation of Guangdong Province, China (2019A1515011463).
  1. Essibayi MA, Oushy SH, Lanzino G, Brinjikji W. Venous causes of pulsatile tinnitus: Clinical presentation, clinical and radiographic evaluation, pathogenesis, and endovascular treatments: A literature review. Neurosurgery. 2021;89(5):760-768. doi: 10.1093/neuros/nyab299


  1. Nicholson P, Brinjikji W, Radovanovic I, et al. Venous sinus stenting for idiopathic intracranial hypertension: A systematic review and meta-analysis. J Neurointerv Surg. 2019;11(4):380-385. doi: 10.1136/neurintsurg-2018-014172


  1. Zhao P, Ding H, Lv H, et al. CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies. Eur Radiol. 2021;31(5):2896-2902. doi: 10.1007/s00330-020-07415-2


  1. Zhao P, Lv H, Dong C, Niu Y, Xian J, Wang Z. CT evaluation of sigmoid plate dehiscence causing pulsatile tinnitus. Eur Radiol. 2016;26:9-14. doi: 10.1007/s00330-015-3827-8


  1. Li Y, Chen H, He L, et al. Hemodynamic assessments of venous pulsatile tinnitus using 4D-flow MRI. Neurology. 2018;91(6):e586-e593. doi: 10.1212/WNL.0000000000005948


  1. Heyu D, Pengfei Z, Han L, et al. A new method for assessing transverse sinus stenosis with CT venography based on the venous trans-stenotic pressure gradient. J Neurointerv Surg. 2023;15(10):1034-1038. doi: 10.1136/jnis-2022-019270


  1. Patel D, Machnowska M, Symons S, et al. Diagnostic performance of routine brain MRI sequences for dural venous sinus thrombosis. AJNR Am J Neuroradiol. 2016;37(11):2026-2032. doi: 10.3174/ajnr.A4843


  1. Ghoneim A, Straiton J, Pollard C, Macdonald K, Jampana R. Imaging of cerebral venous thrombosis. Clin Radiol. 2020;75(4):254-264. doi: 10.1016/j.crad.2019.12.009


  1. Dmytriw AA, Song JS, Yu E, Poon CS. Cerebral venous thrombosis: State of the art diagnosis and management. Neuroradiology. 2018;60:669-685. doi: 10.1007/s00234-018-2032-2


  1. Provenzale JM, Kranz PG. Dural sinus thrombosis: Sources of error in image interpretation. Am J Roentgenol. 2011;196(1):23-31. doi: 10.2214/AJR.10.5323


  1. Lansley JA, Tucker W, Eriksen MR, Riordan-Eva P, Connor SE. Sigmoid sinus diverticulum, dehiscence, and venous sinus stenosis: Potential causes of pulsatile tinnitus in patients with idiopathic intracranial hypertension? Am J Neuroradiol. 2017;38(9):1783-1788. doi: 10.3174/ajnr.A5277


  1. Sarma A, Martin D, Pruthi S, Jones R, Little SB. Imaging the cerebral veins in pediatric patients: Beyond dural venous sinus thrombosis. Radiographics. 2023;43(2):e220129. doi: 10.1148/rg.220129


  1. Pallewatte AS, Tharmalingam T, Liyanage N. Anatomic variants and artefacts in non enhanced MRV-Potential pitfalls in diagnosing cerebral venous sinus thrombosis (CVST). Sri Lanka J Radiol. 2016;2(1):40. doi: 10.4038/sljr.v2i1.23


  1. Kobayashi K, Matsui O, Suzuki M, Ueda F. Anatomical study of the confluence of the sinuses with contrast-enhanced magnetic resonance venography. Neuroradiology. 2006;48:307-311. doi: 10.1007/s00234-006-0065-4


  1. Buyck PJ, Zuurbier SM, Garcia-Esperon C, et al. Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis. Neurology. 2019;92(8):e841-e851. doi: 10.1212/WNL.0000000000006959


  1. Vymazal J, Rulseh AM, Keller J, Janouskova L. Comparison of CT and MR imaging in ischemic stroke. Insights Imaging. 2012;3:619-627. doi: 10.1007/s13244-012-0185-9


  1. Guryildirim M, Kontzialis M, Ozen M, Kocak M. Acute headache in the emergency setting. Radiographics. 2019;39(6):1739-1759. doi: 10.1148/rg.2019190017


  1. Pereira VM, Cancelliere NM, Najafi M, et al. Torrents of torment: Turbulence as a mechanism of pulsatile tinnitus secondary to venous stenosis revealed by high-fidelity computational fluid dynamics. J Neurointerv Surg. 2021;13(8):732-737. doi: 10.1136/neurintsurg-2020-016636


  1. Gao L, Xu W, Li T, et al. Accuracy of magnetic resonance venography in diagnosing cerebral venous sinus thrombosis. Thromb Res. 2018;167:64-73. doi: 10.1016/j.thromres.2018.05.012


  1. Ruíz DS, Gailloud P, Rüfenacht DA, Delavelle J, Henry F, Fasel JH. The craniocervical venous system in relation to cerebral venous drainage. Am J Neuroradiol. 2002;23(9):1500-1508.


  1. Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A. Resolution of pulsatile tinnitus after venous sinus stenting in patients with idiopathic intracranial hypertension. PLoS One. 2016;11(10):e0164466. doi: 10.1371/journal.pone.0164466


  1. Farrag A, Irfan M, Guliani GK, et al. Occurrence of post-acute recanalization and collateral formation in patients with cerebral venous and sinus thrombosis. A serial venographic study. Neurocrit Care. 2010;13:373-379. doi: 10.1007/s12028-010-9394-6


  1. Mazur MD, Cutler A, Couldwell WT, Taussky P. Management of meningiomas involving the transverse or sigmoid sinus. Neurosurg Focus. 2013;35(6):E9. doi: 10.3171/2013.8.FOCUS13340


  1. Sheth SA, Trieu H, Liebeskind DS, et al. Venous collateral drainage patterns predict clinical worsening in dural venous sinus thrombosis. J Neurointervent Surg. 2018;10(2):171-175. doi: 10.1136/neurintsurg-2016-012941


  1. Tanaka M, Imhof HG, Schucknecht B, Kollias S, Yonekawa Y, Valavanis A. Correlation between the efferent venous drainage of the tumor and peritumoral edema in intracranial meningiomas: Superselective angiographic analysis of 25 cases. J Neurosurg. 2006;104(3):382-388. doi: 10.3171/jns.2006.104.3.382


  1. Inamura T, Nishio S, Takeshita I, Fujiwara S, Fukui M. Peritumoral brain edema in meningiomas--influence of vascular supply on its development. Neurosurgery. 1992;31(2):179-185. doi: 10.1227/00006123-199208000-00002


  1. Florisson JM, Barmpalios G, Lequin M, et al. Venous hypertension in syndromic and complex craniosynostosis: The abnormal anatomy of the jugular foramen and collaterals. J Craniomaxillofac Surg. 2015;43(3):312-318.


  1. Huang YC, Lee JD, Pan YT, Weng HH, Yang JT, Lin LC. Perfusion defects and collateral flow patterns in acute small subcortical infarction: A 4D dynamic MRI study. Transl Stroke Res. 2022;13:339-409. doi: 10.1007/s12975-021-00953-x


  1. Venema SM, Dankbaar JW, Wolff L, et al. Collateral status and recanalization after endovascular treatment for acute ischemic stroke. J Neurointerv Surg. 2023;15(6):531-538. doi: 10.1136/neurintsurg-2021-018545


  1. Hatami H, Danesh N, Shojaei M, Hamedani AR. Evaluation of diagnostic values in NCCT and MRI of the patients with cerebral venous or sinus thrombosis in loghman hakim Hospital in Tehran 2014-2018. Int Clin Neurosc J. 2019;6(1):17-21.


  1. Stoumpos S, Tan A, Hall Barrientos P, et al. Ferumoxytol MR angiography versus duplex US for vascular mapping before arteriovenous fistula surgery for hemodialysis. Radiology. 2020;297(1):214-222. doi: 10.1148/radiol.2020200069


  1. Bonatti M, Valletta R, Lombardo F, et al. Accuracy of unenhanced CT in the diagnosis of cerebral venous sinus thrombosis. Radiol Med. 2021;126:399-404. doi: 10.1007/s11547-020-01263-2


  1. Qiu X, Zhao P, Li X, et al. The relationships among transverse sinus stenosis measured by CT venography, venous trans-stenotic pressure gradient and intracranial pressure in patients with unilateral venous pulsatile tinnitus. Front Neurosci. 2021;15:694731. doi: 10.3389/fnins.2021.694731


Conflict of interest
The authors declare that they have no competing interests.
Back to top
Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing