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MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood
  1. J N P Higgins1,
  2. J H Gillard1,
  3. B K Owler2,
  4. K Harkness3,
  5. J D Pickard4
  1. 1Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
  2. 2Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, Australia
  3. 3Department of Neurology, Addenbrooke’s Hospital
  4. 4Academic Neurosurgical Unit, Addenbrooke’s Hospital
  1. Correspondence to:
 Dr Nicholas Higgins
 Department of Radiology, Box 219, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; nick.higginsaddenbrookes.nhs.uk

Abstract

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.

  • idiopathic intracranial hypertension
  • magnetic resonance venography
  • cerebral venous sinus
  • MRV, magnetic resonance venography
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Footnotes

  • Competing interests: none declared

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