From the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
From the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.).
AJNR Am J Neuroradiol. 2021 Nov;42(11):1993-2000. doi: 10.3174/ajnr.A7311. Epub 2021 Oct 7.
The correlation between imaging findings and clinical status in patients with idiopathic intracranial hypertension is unclear. We aimed to examine the evolution of idiopathic intracranial hypertension-related MR imaging findings in patients treated with venous sinus stent placement.
Thirteen patients with idiopathic intracranial hypertension (median age, 26.9 years) were assessed for changes in the CSF opening pressure, transstenotic pressure gradient, and symptoms after venous sinus stent placement. Optic nerve sheath diameter, posterior globe flattening and/or optic nerve protrusion, empty sella, the Meckel cave, tonsillar ectopia, the ventricles, the occipital emissary vein, and subcutaneous fat were evaluated on MR imaging before and 6 months after venous sinus stent placement. Data are expressed as percentages, medians, or correlation coefficients () with values.
Although all patients showed significant reductions of the CSF opening pressure (31 versus 21 cm HO; = .005) and transstenotic pressure gradient (22.5 versus 1.5 mm Hg; = .002) and substantial improvement of clinical symptoms 6 months after venous sinus stent placement, a concomitant reduction was observed only for posterior globe involvement (61.5% versus 15.4%; = .001), optic nerve sheath diameter (6.8 versus 6.1 mm; < .001), and subcutaneous neck fat (8.9 versus 7.4 mm; = .001). Strong correlations were observed between decreasing optic nerve sheath diameters and improving nausea/emesis (right optic nerve sheath diameter, = 0.592, = .033; left optic nerve sheath diameter, = 0.718, = .006), improvement of posterior globe involvement and decreasing papilledema ( = 0.775, = .003), and decreasing occipital emissary vein diameter and decreasing headache frequency ( = 0.74, = .035). Decreasing transstenotic pressure gradient at 6 months strongly correlated with decreasing empty sella ( = 0.625, = .022) and regressing cerebellar ectopia (= 0.662, = .019).
Most imaging findings persist long after normalization of intracranial pressure and clinical improvement. However, MR imaging findings related to the optic nerve may reflect treatment success.
特发性颅内高压患者的影像学表现与临床状况之间的相关性尚不清楚。我们旨在研究静脉窦支架置入治疗后特发性颅内高压相关磁共振成像（MRI）表现的演变。
评估了 13 例特发性颅内高压患者（平均年龄 26.9 岁）在静脉窦支架置入后 CSF 开口压力、跨狭窄段压力梯度和症状变化情况。在静脉窦支架置入前和 6 个月后对视神经鞘直径、球后平坦和/或视神经突出、空蝶鞍、 Meckel 腔、扁桃体异位、脑室、枕骨导静脉和皮下脂肪进行 MRI 评估。数据以百分比、中位数或相关系数（r 值）表示，以 p 值表示。
尽管所有患者的 CSF 开口压力（31 对 21cmH2O；p=0.005）和跨狭窄段压力梯度（22.5 对 1.5mmHg；p=0.002）均显著降低，临床症状也明显改善，但仅观察到球后受累（61.5%对 15.4%；p=0.001）、视神经鞘直径（6.8 对 6.1mm；p<0.001）和颈皮下脂肪（8.9 对 7.4mm；p=0.001）同时减少。视神经鞘直径的减小与恶心/呕吐的改善呈强相关（右侧视神经鞘直径，r=0.592，p=0.033；左侧视神经鞘直径，r=0.718，p=0.006），球后受累的改善与视乳头水肿的减轻呈强相关（r=0.775，p=0.003），枕骨导静脉直径的减小与头痛频率的降低呈强相关（r=0.74，p=0.035）。6 个月时跨狭窄段压力梯度的降低与空蝶鞍的减小（r=0.625，p=0.022）和小脑异位的消退（r=0.662，p=0.019）呈强相关。
大多数影像学表现在颅内压正常和临床症状改善后仍长期存在。然而，与视神经相关的 MRI 表现可能反映了治疗效果。
