Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension

Fellows’ Journal Club

MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured. Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with IIH and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with IIH and 7% of controls. The authors conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.

Abstract

Figure 1 from paper
A–C, Transverse sinus stenosis on coronal T1 postgadolinium MR imaging. A and B, Images from a 43-year-old female patient with idiopathic intracranial hypertension. CSF opening pressure was 380 mm H2O. Postgadolinium coronal 3D fast-spoiled gradient recalled images, section thickness = 2.4 mm, demonstrate stenosis of the transverse sinuses bilaterally (arrows). The expected Δ configuration is distorted and collapsed bilaterally (A). This is more easily appreciated on images from within the same study by comparing with the images of the same sinuses more posteriorly (B). C and D, Images from a 36-year-old female patient with IIH. CSF opening pressure was 370 mm H2O. Postgadolinium T1-weighted image (C) with coronal reformatting from a 3D acquisition, with a section thickness = 2 mm, TR = 650 ms, TE = 12 ms; and oblique projectional image from a gadolinium-bolused MRV sequence, with TR = 3.83 ms and TE = 1.39 ms. Stenoses of the transverse sinuses are evident on both images (arrows). E and F, Coronal T1-weighted image from a 32-year-old female patient with IIH. CSF opening pressure was 304 mm H2O. Virtually complete collapse of the transverse sinuses can be discerned bilaterally (arrows). A sagittal raw data image (F) from the gadolinium-bolused MRV, section thickness = 0.66 mm, suggests an appearance of herniation of the temporo-occipital tissues into the transverse sinus space. G, By contrast, an image from a control patient, a 49-year-old woman with multiple medical problems but no specific explanation for her symptoms of headache. A coronal postgadolinium T1-weighted image, section thickness = 4 mm, shows the expected Δ configuration (arrows) of the preserved transverse sinuses bilaterally.

BACKGROUND AND PURPOSE

Patients with idiopathic intracranial hypertension have transverse sinus stenosis on gadolinium-bolused MRV, but other MR imaging signs are less consistently seen. Our aim was to demonstrate that transverse sinus stenosis could be identified on conventional MR imaging, and this identification would allow improved diagnostic sensitivity to this condition.

MATERIALS AND METHODS

MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured from the MRV examinations, and the cross-sectional area of the transverse sinus was calculated. Correlation among the 3 modes of evaluation of the transverse sinus was conducted by using Wilcoxon/Kruskal-Wallis, Pearson, and Spearman ρ nonparametric statistical techniques.

RESULTS

Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with idiopathic intracranial hypertension and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with idiopathic intracranial hypertension and 7% of controls. Previously described MR imaging signs of intracranial hypertension were identified in 8%–61% of patients with idiopathic intracranial hypertension. Correlation among the 3 modes of evaluation was highly significant (P < .0001).

CONCLUSIONS

Even without the assistance of an MRV sequence, neuroradiologists can validly identify bilateral transverse sinus stenosis in patients with intracranial hypertension more reliably than other previously described MR imaging findings in this condition. We conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.

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Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.

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