HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Higgins, J N P Articles by Pickard, J D Search for Related Content PubMed PubMed Citation Articles by Higgins, J N P Articles by Pickard, J D

MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood

¹ Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
² Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, Australia
³ Department of Neurology, Addenbrooke’s Hospital
⁴ Academic Neurosurgical Unit, Addenbrooke’s Hospital

Correspondence to:
Correspondence to:
Dr Nicholas Higgins
Department of Radiology, Box 219, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; nick.higgins{at}addenbrookes.nhs.uk

Background: Venous sinus disease must be excluded before diagnosing idiopathic intracranial hypertension but is found only rarely in typical cases. Magnetic resonance venography (MRV) is the technique of choice for investigating this, and provides images that are diagnostic and easy to interpret. However, recent work using more invasive techniques has documented pressure gradients and stenoses in the lateral venous sinuses in many cases of idiopathic intracranial hypertension.

Objective: To examine the reason for this discrepancy and to establish whether there are characteristic appearances on MRV in idiopathic intracranial hypertension that are routinely overlooked in clinical practice.

Methods: MRVs from 20 patients with idiopathic intracranial hypertension were reviewed, unblinded, by two neuroradiologists, and their appearances rated for focal narrowings and signal gaps. A control group of 40 asymptomatic volunteers, matched for age and sex with the patient group, was recruited prospectively for MRV, and their scans rated in the same way.

Results: The lateral sinuses presented a range of appearances with quite different distributions in the two groups (p<0.001). Bilateral lateral sinus flow gaps were seen in 13 of 20 patients with idiopathic intracranial hypertension and in none of 40 controls.

Conclusions: A historical failure to use normal healthy controls to establish the boundaries between imaging artefact, normal anatomical variant, and disease means that the pathological significance of the different appearances of the lateral sinuses on MRV has not so far been appreciated.

Keywords: idiopathic intracranial hypertension; magnetic resonance venography; cerebral venous sinus

Abbreviations: MRV, magnetic resonance venography

This article has been cited by other articles:

				D. Zervakis, P. Angelidakis, P. Dedeilias, and A. Koutsoukou Cerebral vein thrombosis after coronary artery bypass surgery Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 514 - 516. [Abstract] [Full Text] [PDF]

				E. Widjaja, M. Shroff, S. Blaser, S. Laughlin, and C. Raybaud 2D Time-of-Flight MR Venography in Neonates: Anatomy and Pitfalls. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1913 - 1918. [Abstract] [Full Text] [PDF]

				J. L. Leach, R. B. Fortuna, B. V. Jones, and M. F. Gaskill-Shipley Imaging of Cerebral Venous Thrombosis: Current Techniques, Spectrum of Findings, and Diagnostic Pitfalls RadioGraphics, October 1, 2006; 26(suppl_1): S19 - S41. [Abstract] [Full Text] [PDF]

				F. Bono, D. Messina, C. Giliberto, D. Cristiano, G. Broussard, F. Fera, F. Condino, A. Lavano, and A. Quattrone Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine Neurology, August 8, 2006; 67(3): 419 - 423. [Abstract] [Full Text] [PDF]

				F. Bono, C. Giliberto, C. Mastrandrea, D. Cristiano, A. Lavano, F. Fera, and A. Quattrone Transverse sinus stenoses persist after normalization of the CSF pressure in IIH Neurology, October 11, 2005; 65(7): 1090 - 1093. [Abstract] [Full Text] [PDF]

				G. Sebire, B. Tabarki, D. E. Saunders, I. Leroy, R. Liesner, C. Saint-Martin, B. Husson, A. N. Williams, A. Wade, and F. J. Kirkham Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome Brain, March 1, 2005; 128(3): 477 - 489. [Abstract] [Full Text] [PDF]

				J. N. P. Higgins and J. D. Pickard Lateral sinus stenoses in idiopathic intracranial hypertension resolving after CSF diversion Neurology, May 25, 2004; 62(10): 1907 - 1908. [Full Text] [PDF]