Importance Of Anatomical Imaging Signs In Predicting The Transverse Sinus Dominance Using Conventional Magnetic Resonance Imaging

Abstract

Background: The cerebral venous system comprises both superficial and deep veins, which contain nearly 70% of the brain’s blood volume and play a crucial role in maintaining normal cerebral perfusion.

Subject and methods: A retrospective study was conducted at Rizgary Teaching Hospital from January 1st, 2025, to November 1st, 2025. A convenient sample of 100 patients' MRI reports was reviewed. The first section of the questionnaire included gender, age, and indications for Magnetic Resonance Imaging. Signs and symptoms such as headache, headache with vertigo, seizure, headache and vomiting, dizziness, altered sensorium, and forgetfulness were documented. Categorical data was tested with the Chi-square test, and numerical data with the t-test. A P-value ≤0.05 was considered significant.

Results: The prevalence of females presenting with headaches was higher than that of males, at 75% compared to 67.5%. Headache and vomiting were more common in males (25%) than in females (15%). No statistically significant difference was reported between gender and the TS symmetrical and asymmetrical variation. The prevalence of asymmetry was 85% in males compared to 81.7% in females. The prevalence of left hypoplastic transfer sinus was higher than that of the right hypoplastic transfer sinus. The highest predictive value (96%) for diagnosing the laterality of the dominant TS was reported by gSSS inclination, with an interobserver reliability of 0.82. SSS flow-void laterality had the second-highest reliability for determining TS dominance, at 92%.

Conclusion and recommendation: Several anatomical features visible on MRI can predict TS dominance laterality. Right TS dominance is indicated by a gSSS that slopes downward to the right, with the SSS flow void positioned to the right of the more prominent, rightward angulation of the posterior falx, and a more inferiorly located left occipital lobe. The orientation of the gSSS to the right or left is strongly associated with and highly predictive of right- and left-sided TS dominance laterality.