Original Research

Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging

Svetlana Lublinsky MS

orcid.org/0000-0002-0390-4887

Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Anat Kesler MD,

Anat Kesler MD

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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Alon Friedman MD,

Alon Friedman MD

Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada

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Anat Horev MD,

Anat Horev MD

Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel

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Ilan Shelef MD,

Corresponding Author

Ilan Shelef MD

[email protected]

Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel

Address reprint requests to: I.S., Soroka University Medical Center, Diagnostic Imaging Department, PO Box 151, Beer-Sheva 84101, Israel. E-mail: [email protected]Search for more papers by this author

Svetlana Lublinsky MS,

Svetlana Lublinsky MS

orcid.org/0000-0002-0390-4887

Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Anat Kesler MD,

Anat Kesler MD

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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Alon Friedman MD,

Alon Friedman MD

Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada

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Anat Horev MD,

Anat Horev MD

Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel

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Ilan Shelef MD,

Corresponding Author

Ilan Shelef MD

[email protected]

Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel

First published: 27 September 2017

https://doi.org/10.1002/jmri.25857

Citations: 13

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Abstract

Background

Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a clear cause.

Purpose

To investigate dynamic imaging findings in IIH and their relation to mechanisms underlying intracranial pressure normalization.

Study Type

Prospective.

Population

Eighteen IIH patients and 30 healthy controls.

Field Strength/Sequence

T₁-weighted, venography, fluid attenuation inversion recovery, and apparent diffusion coefficients were acquired on 1.5T scanner.

Assessment

The dural sinus was measured before and after lumbar puncture (LP). The degree of sinus occlusion was evaluated, based on 95% confidence intervals of controls. We studied a number of neuroimaging biomarkers associated with IIH (sinus occlusion; optic nerve; distribution of cerebrospinal fluid into the subarachnoid space, sulci and lateral ventricles (LVs); Meckel's caves; arachnoid granulation; pituitary and choroid plexus), before and after LP, using a set of specially developed quantification techniques.

Statistical Tests

Relationships among various biomarkers were investigated (Pearson correlation coefficient) and linked to long-term disease outcomes (logistic regression). The t-test and the Wilcoxon rank test were used to compare between controls and before and after LP data.

Results

As a result of LP, the following were found to be in good accordance with the opening pressure: relative compression of cerebrospinal fluid (R = –0.857, P < 0.001) and brain volumes (R = –0.576, P = 0.012), LV expansion (R = 0.772, P < 0.001) and venous volume (R = 0.696, P = 0.001), enlargement of the pituitary (R = 0.640, P = 0.023), and shrinkage of subarachnoid space (R = –0.887, P < 0.001). The only parameter that had an impact on long-term prognosis was cross-sectional size of supplemental drainage veins after LP (sensitivity of 92%, specificity of 20%, and area under the curve of 0.845, P < 0.001).

Data Conclusion

We present an approach for quantitative characterization of the intracranial venous system and its implementation as a diagnostic assistance tool. We conclude that formation of supplementary drainage veins might serve as a long-lasting compensatory mechanism.

Level of Evidence: 2

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2018;47:913–927.

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Citing Literature

Volume47, Issue4

April 2018

Pages 913-927

Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Information

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Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature

References

Related

Information