Hounsfield Unit-to-Hematocrit Ratio as a Quantitative Marker for Cerebral Venous Sinus Thrombosis: A Retrospective Diagnostic Study

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Hounsfield Unit-to-Hematocrit Ratio as a Quantitative Marker for Cerebral Venous Sinus Thrombosis: A Retrospective Diagnostic Study

Authors

  • Muhammad Yunus Amran Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia https://orcid.org/0000-0001-5079-7490
  • M Fajrin Hidayah Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia https://orcid.org/0009-0008-2947-4513
  • Muhammad Akbar Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
  • Andi Kurnia Bintang Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
  • Irbab Hawari Department of Neurology, Al- Azhar Islamic University, Mataram, Indonesia

Keywords:

Cerebral venous sinus thrombosis, HU/Hct ratio, Hounsfield Unit , Hematocrit, Platelet count, headache, dizziness

Abstract

Background and Aim: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition that requires advanced imaging modalities, such as magnetic resonance venography (MRV) or computed tomography venography (CTV), for diagnosis. However, access to these diagnostic tools is often limited in resource-constrained settings. There is an unmet need for simpler, cost-effective, and rapid diagnostic methods to facilitate early detection of CVST. This study aims to evaluate the utility of the Hounsfield unit (HU)/ hematocrit (Hct) ratio derived from non-contrast CT imaging as a novel diagnostic marker for CVST and explore its correlation with hematological parameters, while identifying common symptoms and demographic patterns.

Methods: This cross-sectional study was conducted between September and October 2024. Data were collected retrospectively from patients diagnosed with CVST between January 2022 and August 2024 at a tertiary care center. The study variables included Hct, platelet count (Plt), HU values from CT scans, and the HU/Hct ratio. Data were analyzed and presented in summary tables, focusing on the relationship between imaging and hematological parameters.

Results: A total of 93 patients with CVST were identified, with 74.2% being female and a mean age of 40 years. After applying inclusion criteria, 34 patients were analyzed. The study revealed a significant negative correlation between Hct and the HU/Hct ratio (p = 0.001). No significant correlation was observed between Plt and HU or the HU/Hct ratio. Common clinical presentations included headache (84%) and dizziness (35%), with CVST predominantly affecting women of reproductive age.

Conclusion: The HU/Hct ratio demonstrates potential as an accessible and reliable diagnostic marker for CVST, particularly in resource-limited settings where advanced imaging is unavailable. This quantitative parameter could complement existing diagnostic workflows and aid in the early detection of CVST. Further validation through multicenter studies is recommended to establish its broader applicability.

Author Biographies

Muhammad Yunus Amran, Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine,   Hasanuddin University, Makassar, Indonesia

M Fajrin Hidayah, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Muhammad Akbar, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Andi Kurnia Bintang, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Irbab Hawari, Department of Neurology, Al- Azhar Islamic University, Mataram, Indonesia

Department of Neurology, Al- Azhar Islamic University, Mataram, Indonesia

References

Ferro JM, Bousser MG, Canhão P, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203-1213. doi:10.1111/ene.13381

Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-1798. doi:10.1056/NEJMra042354

Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral Venous Thrombosis: A Comprehensive Review. Eur Neurol. 2020;83(4):369-379. doi:10.1159/000509802

Dash D, Prasad K, Joseph L. Cerebral venous thrombosis: An Indian perspective. Neurol India. 2015;63(3):318-328. doi:10.4103/0028-3886.158191

Payne AB, Adamski A, Abe K, et al. Epidemiology of cerebral venous sinus thrombosis and cerebral venous sinus thrombosis with thrombocytopenia in the United States, 2018 and 2019. Res Pract Thromb Haemost. 2022;6(2):e12682. Published 2022 Mar 7. doi:10.1002/rth2.12682

Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012; 43 (12): 3375-3377. doi:10.1161/STROKEAHA.112.671453

Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously Thought: A Retrospective Population-Based Study. Stroke. 2016;47(9):2180-2182. doi:10.1161/STROKEAHA.116.013617

Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158-1192. doi:10.1161/STR.0b013e31820a8364

Linn J, Pfefferkorn T, Ivanicova K, et al. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. AJNR Am J Neuroradiol. 2009;30(4):728-735. doi:10.3174/ajnr. A1451

Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006;26 Suppl 1: S19-S43. doi:10.1148/rg.26si055174

Buyck PJ, De Keyzer F, Vanneste D, Wilms G, Thijs V, Demaerel P. CT density measurement and H:H ratio are useful in diagnosing acute cerebral venous sinus thrombosis. AJNR Am J Neuroradiol. 2013;34(8):1568-1572. doi:10.3174/ajnr.A3469

Ratnaparkhi C, Dhok A, Gupta A, Dube A, Kurmi B, Umredkar A, Kumar S, Pande S, Ghatol S. Diagnostic Accuracy of Hounsfield Unit Value and Hounsfield Unit to Hematocrit Ratio in Predicting Cerebral Venous Sinus Thrombosis: A Retrospective Case-Control Study. Cureus. 2024 Apr 3;16(4): e57567. doi: 10.7759/cureus.57567. PMID: 38707168; PMCID: PMC11069020.

Roland T, Jacobs J, Rappaport A, Vanheste R, Wilms G, Demaerel P. Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis. Clin Radiol. 2010;65(1):34-39. doi:10.1016/j.crad.2009.09.008

Zaheer S, Iancu D, Seppala N, et al. Quantitative non-contrast measurements improve diagnosing dural venous sinus thrombosis. Neuroradiology. 2016;58(7):657-663. doi:10.1007/s00234-016-1681-2

Digge P, Prakashini K, Bharath KV. Plain CT vs MR venography in acute cerebral venous sinus thrombosis: Triumphant dark horse. Indian J Radiol Imaging. 2018;28(3):280-284. doi:10.4103/ijri.IJRI_328_17

Uluduz D, Sahin S, Duman T, et al. Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study. Stroke Res Treat. 2020;2020:8610903. Published 2020 Sep 1. doi:10.1155/2020/8610903

Ciarambino T, Crispino P, Minervini G, Giordano M. Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship. Biomedicines. 2023;11(5):1280. Published 2023 Apr 26. doi:10.3390/biomedicines11051280

Saposnik G, Bushnell C, Coutinho JM, et al. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke. 2024;55(3):e77-e90. doi:10.1161/STR.0000000000000456

Luo Y, Tian X, Wang X. Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. Front Aging Neurosci. 2018;10:2. Published 2018 Jan 30. doi:10.3389/fnagi.2018.00002

Furie KL, Cushman M, Elkind MSV, Lyden PD, Saposnik G; American Heart Association/American Stroke Association Stroke Council Leadership. Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia. Stroke. 2021;52(7):2478-2482. doi:10.1161/STROKEAHA.121.035564

Khan MWA, Zeeshan HM, Iqbal S. Clinical Profile and Prognosis of Cerebral Venous Sinus Thrombosis. Cureus. 2020;12(12):e12221. Published 2020 Dec 22. doi:10.7759/cureus.12221

Shayganfar A, Azad R, Taki M. Are cerebral veins hounsfield unit and H: H ratio calculating in unenhanced CT eligible to diagnosis of acute cerebral vein thrombosis?. J Res Med Sci. 2019;24:83. Published 2019 Sep 30. doi:10.4103/jrms.JRMS_1027_18

Yang Y, Cheng J, Peng Y, et al. Clinical features of patients with cerebral venous sinus thrombosis at plateau areas. Brain Behav. 2023;13(6):e2998. doi:10.1002/brb3.2998

Canakci ME, Acar N, Kuas C, et al. Diagnostic Value of Hounsfield Unit and Hematocrit Levels in Cerebral Vein Thrombosis in the Emergency Department. J Emerg Med. 2021;61(3):234-240. doi:10.1016/j.jemermed.2021.07.016

Walton BL, Lehmann M, Skorczewski T, et al. Elevated hematocrit enhances platelet accumulation following vascular injury. Blood. 2017;129(18):2537-2546. doi:10.1182/blood-2016-10-746479

Nurmin R, Lismayanti L, Rostini T, et al. Correlation between P-selectin level and platelet aggregation in cerebral venous sinus thrombosis patients. Maj Kedokt Bandung. 2023;55(3):191-196. doi:10.15395/mkb.v55n3.2777

Madineni KU, Prasad SVN, Bhuma V. A study of the prognostic significance of platelet distribution width, mean platelet volume, and plateletcrit in cerebral venous sinus thrombosis. J Neurosci Rural Pract. 2023;14(3):418-423. doi:10.25259/JNRP-2021-1-3-R2-(1431)

Akhavan R, Abbasi B, Kheirollahi M, et al. Factors affecting dural sinus density in non-contrast computed tomography of brain. Sci Rep. 2019;9(1):12016. Published 2019 Aug 19. doi:10.1038/s41598-019-48545-y

How to Cite

1.
Amran MY, Hidayah M, Akbar M, Bintang A, Hawari I. Hounsfield Unit-to-Hematocrit Ratio as a Quantitative Marker for Cerebral Venous Sinus Thrombosis: A Retrospective Diagnostic Study. Acta Biomed. 96(4):16843. doi:10.23750/abm.vi.16843

Issue

Vol. 96 No. 4 (2025)

Section

ORIGINAL CLINICAL RESEARCH
DOI: https://doi.org/10.23750/abm.vi.16843

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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How to Cite

1.
Amran MY, Hidayah M, Akbar M, Bintang A, Hawari I. Hounsfield Unit-to-Hematocrit Ratio as a Quantitative Marker for Cerebral Venous Sinus Thrombosis: A Retrospective Diagnostic Study. Acta Biomed. 96(4):16843. doi:10.23750/abm.vi.16843
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