Imaging of the intracranial venous system

BACKGROUND: Evaluation of the intracranial venous system has historically been performed with conventional catheter-based digital subtraction angiography (DSA). The continued importance of DSA can not be overstated in light of its inherent option of endovascular intervention and thrombolysis for cerebral venous thrombosis. DSA is, however, an invasive procedure with associated risks, including radiation exposure, and adverse effects of iodinated contrast medium. DSA also suffers from the limitations of 2-dimensional planar imaging. For these reasons, noninvasive imaging techniques are playing a greater role in evaluation of the intracranial venous system. REVIEW SUMMARY: This review provides an overview of the current noninvasive methods and their applications and limitations, with examples of their use in a variety of disease processes. Computed tomography venography (CTV) is discussed as well as the various types of cerebral magnetic resonance venography (MRV). CONCLUSION: When available, MR supplemented with the technique of triggered gadolinium-enhanced MRV is the method of choice for the diagnosis of dural sinus thrombosis as well as most other pathologic entities affecting the intracranial venous system.