Value of double - track sign in differentiating primary from thrombosed transverse sinus stenosis in patients presumed to have idiopathic intracranial hypertension

BACKGROUND: Idiopathic intracranial hypertension (IIH) is primarily a disorder of young obese women of unknown etiology. The clinical presentation of IIH is similar to that of sinus thrombosis. The incidence of transverse sinus stenosis (TSS) reaches up to 90% of patients with IIH compared with normal subjects, and venous sinus thrombosis was reported in 11.4% of patients previously diagnosed as having IIH. Patients with thrombosis showed an abnormal region of double- track pattern on gadolinium (Gd) – enhanced T1WI within the dural sinus. AIM: This study aims to evaluate whether double - track sign can differentiate primary TSS from thrombosed TSS in patients presumed to have IIH based on Gd - enhanced MRI. METHODS: This study was a retrospective multicenter observational case control study. The clinical and radiological data for all adult patients with presumed IIH were collected. The diagnosis of TSS was made based on further evaluation by DSA or MRV. RESULTS: Fifty-nine sinuses were diagnosed as a transverse sinus stenosis. Eight sinuses (13.6%) were partially occluded by recanalized thrombus. Double track sign was detected in seven (87.5%) of the thrombosed sinuses. CONCLUSION: The double track sign remains much sensitive for the detection of transverse sinus thrombosis (TST) and it might provide an early clue for the dural sinus thrombosis in patients presumed to have IIH.