Diagnostic value of MR black-blood thrombus imaging, contrast-enhanced MRI, and noncontrast-enhanced MR venography in cerebral vein thrombosis: a systematic review and meta-analysis.

Abstract

The diagnosis of cerebral venous thrombosis (CVT) remains challenging due to limited consensus on the optimal imaging modality. MR black-blood thrombus imaging (MRBTI), contrast-enhanced MR imaging (CE-MRI), and noncontrast-enhanced MR venography (NCE-MRV) are promising modalities. This study aims to evaluate the performance of these modalities in diagnosing CVT. PubMed, Web of Science, and Embase databases were systematically searched from inception to March 2025. Studies evaluating the diagnostic accuracy of MRBTI, CE-MRI, and NCE-MRV for CVT were included. A bivariate random-effects model was used to calculate the summary accuracy metrics with 95% confidence intervals (CIs). Sources of heterogeneity were explored through meta-regression, subgroup analysis, and sensitivity analysis. Publication bias was assessed using Deeks' funnel plot. Fifteen studies involving 49 cohorts (1401 patients and 4846 venous segments) were included. MRBTI achieved significantly higher sensitivity, 98% (95% CI: 95-99%), and specificity, 99% (95% CI: 97-100%) than CE-MRI and NCE-MRV (p < 0.05 for both). NCE-MRV (89%; 95% CI: 78-95%) demonstrated higher sensitivity than CE-MRI (76%; 95% CI: 67-83%) (p = 0.045), at the expense of specificity (NCE-MRV: 89%, 95% CI: 79-94%; CE-MRI: 97%, 95% CI: 93-98%; p = 0.04). Study design influenced heterogeneity in both MRBTI and CE-MRI studies, with diagnostic level and scanning mode affecting heterogeneity in MRBTI and CE-MRI, respectively. MRBTI demonstrated superior diagnostic accuracy for CVT compared to CE-MRI and NCE-MRV. Prospective multi-center studies are required to standardize MRBTI protocols and validate its reliability as a standalone diagnostic modality for CVT. Question The diagnostic accuracy for CVT of MRBTI, CE-MRI, and NCE-MRV remains unclear. Findings Pooled data demonstrate that MRBTI exhibits superior diagnostic performance for CVT in comparison with CE-MRI and NCE-MRV. Clinical relevance MRBTI demonstrates high diagnostic accuracy for CVT, facilitating earlier diagnosis and improving patient outcomes. Further studies should standardize MRBTI protocols and validate its reliability as a standalone diagnostic tool for CVT, thereby optimizing workflow, reducing scan time, and improving cost-effectiveness.