Purpose <p>To determine the diagnostic merit of using quantitative imaging parameters measured on non-contrast CT (NCCT) in the diagnosis of cerebral venous thrombosis (CVT).</p> Materials and methods <p>43 patients with CVT and 30 age and sex-matched controls were enrolled in this retrospective study. Two blinded neuroradiologists independently assessed the NCCT scans for direct and indirect signs of CVT. Absolute attenuation values of thrombosed and non-thrombosed sinuses were measured and the ratio of sinus attenuation to patient’s hematocrit (H/H ratio) was calculated for each case. The attenuation value of the internal carotid artery was also measured to calculate the veno-arterial (V/A) difference. Inter-reader agreement was evaluated and all measurements were compared between patient and control groups.</p> Results <p>The sensitivity and specificity of the dense sinus sign for diagnosis of CVT ranged from 72 to 79% and from 83 to 87% respectively. Sinus attenuation, H/H ratio and V/A difference were significantly higher in the CVT group than in the control group (<i>P</i> &lt; 0.0001). An attenuation threshold value of &gt; 55 HU yielded a sensitivity of 86% and a specificity of 90% and had the largest AUC of 0.89 (95%CI 0.795–0.951) among all stand-alone parameters, while the combination of an attenuation value greater than 55, or a V/A difference greater than 22, yielded the best diagnostic performance among all the parameters with sensitivity and specificity at values of 86% and a 100% respectively and an AUC of 0.93 (95%CI 0.846 to 0.977).</p> Conclusions <p>Overall, the analysis of quantitative parameters resulted in a notable upgrade in the accuracy of the diagnosis of CVT over visual inspection alone. Their high specificities make them reliable markers of CVT, yet their relatively lower sensitivities may indicate a need to perform further studies to safely eliminate the possibility of CVT in highly suspicious cases.</p> <p>Trial registration number: FMASU R 10/2020/2021.</p>