| Summary: | <i>Purpose</i>: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). <i>Methods</i>: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. <i>Results</i>: Neuroradiologists identified non-pathological opacification of the CS (<i>n</i> = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (<i>p</i> < 0.0001 for CS, <i>p</i> < 0.0001 for SPS, <i>p</i> < 0.0001 for IPS, and <i>p</i> < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: <i>n</i> = 21, 27.3%; TOF-MRA: <i>n</i> = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (<i>κ</i> = 0.10, 95% confidence interval: −0.12–0.32). <i>Conclusion</i>: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.
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