Intracranial venous thrombosis imaging by anatomical location: an educational review with mimics and diagnostic pitfalls

Abstract Intracranial venous thrombosis encompasses diverse etiologies with clinical presentations ranging from an incidental finding to coma and death. Despite potentially devastating consequences, venous thrombosis is frequently overlooked by radiologists due to its predominantly extraaxial location close to the skull and clinical emphasis on arterial imaging evaluation in acute stroke management. This educational review addresses common and uncommon presentations across all anatomical locations of intracranial venous thrombosis, providing practical pearls and pitfalls for diagnostic interpretation. We review the imaging modalities CT and MRI, together with their venographic techniques, correlating imaging findings with anatomical location, thrombus age and signal evolution, complications, and underlying causes. Critical interpretive pitfalls are highlighted with strategies to avoid misdiagnosis. The review also emphasizes the important yet underrecognized association between intracranial pressure disorders and venous thrombosis, providing radiologists with a practical framework for improved diagnostic accuracy. Key Points Question How can radiologists systematically recognize intracranial venous thrombosis across all anatomical locations and avoid the diagnostic pitfalls that lead to clinically significant missed diagnoses? Findings Location-specific imaging patterns, thrombus signal evolution, and recognition of common mimics such as arachnoid granulations enable accurate detection using combined non-contrast and venographic sequences. Critical relevance statement By organizing intracranial venous thrombosis imaging anatomically and pairing each location with its specific mimics and pitfalls, this review equips radiologists with a practical framework to improve detection accuracy and prevent clinically significant missed diagnoses.