Acquisition Gradient-Echo Versus Magnetic Resonance Venography in the Evaluation of Dural Venous Sinuses

Background: The dural venous sinuses are a network of venous channels located within the dura mater. Disorders of these sinuses can lead to serious consequences. Recent studies indicate that dural venous sinus disorders are more common than previously thought, due to significant advancements in magnetic resonance imaging and high-resolution computed tomography scans. Aims: To assess the value of contrast enhanced Magnetization prepared rapid acquisition gradient-echo versus magnetic resonance venography in the evaluation of dural venous sinuses. Methods: This is a cross-sectional study. It was conducted at the Department of Radiology Baghdad teaching hospital, Medical City complex and Al Imamain Al Khadhimain medical city from February 1, 2025, to December 30, 2025. 193 patients enrolled in this study. The images were independently reviewed by two experienced radiologists blinded to clinical data and imaging results. The presence of normal venous anatomy or if there are anatomical variants and clinically significant pathology were documented. The final diagnosis was based on a composite reference standard that included; interpretation of all magnetic resonance imaging sequences with clinical presentation of the patients. Results: The mean age of the study participants was 43.35 ± 17.41years and the patients age was ranged from 26-65 years. Of the included patients, 125 were female and 68 were male, yielding a female-to-male ratio of 1.838:1. There was significant inter-observer agreement for the assessment of normal venous anatomy, anatomical variants, and pathological findings. In addition, the two imaging sequences demonstrated significant agreement for normal findings and moderate agreement for both anatomical variants and pathological findings. A statistically significant difference was observed between MPRAGE and MRV with respect to image quality (P = 0.011) and image clarity (P < 0.001). Furthermore, contrast enhanced Magnetization prepared rapid acquisition gradient-echo showed superior diagnostic performance compared with magnetic resonance venography in differentiating normal venous anatomy from normal anatomical variants, pathological findings, and normal anatomical variants from pathological conditions, as well as in distinguishing acute from chronic venous sinus thrombosis. Conclusions: Contrast enhanced Magnetization Prepared Rapid Acquisition Gradient Echo had superior sensitivity, specificity, positive predictive value, negative predictive value and accuracy than magnetic resonance venography in showing normal venous architectural, normal anatomical variants and diagnosing dural venous disorders. However, the final diagnosis is depended on combination of these sequences.