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<meta name="DC.Title" content="MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2120" />
<meta name="DC.Date" content="2010-10-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Craniospinal hyper- or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.

MATERIALS AND METHODS: Nineteen patients with CSH were prospectively studied. Three readers assessed the width of the peri-optical CSF rim at 4 different anatomic positions by using coronal STIR sequences from a 3T MR imaging scanner. The height of the pituitary gland was also measured. Results were compared with normal values obtained with the same imaging technique. Qualitative signs of CSH also recorded were engorgement of venous sinuses, dural enhancement, subdural effusion, narrow ventricles, and sagging brain.

RESULTS: CSF signal intensity surrounding the optic nerves was diminished in at least 2 of the 4 positions used for measurements so that decreased diameters of the ONSs were observed in all patients (sensitivity, 100%; specificity, 97%). The height of the pituitary gland was above normal limits in 12 of 19 patients (sensitivity, 63%; specificity, 97%). Frequencies of qualitative signs of CSH varied from 32% to 81%.

CONCLUSIONS: The ISSON in patients with CSH is partially or fully collapsed due to reduced CSF content. In comparison with other anatomic markers, this sign showed the highest sensitivity for the diagnosis of patients with CSH in this study.

CI
:   confidence interval
CSH
:   craniospinal hypotension
FLAIR
:   fluid-attenuated inversion recovery
GRE
:   gradient-recalled echo
ICC
:   intraclass correlation coefficient
ISSON
:   intersheath space of the optic nerve
LP
:   lumbar puncture
MM
:   millimeter
MRI
:   MR imaging
MRV
:   3D phase-contrast MR venography
N
:   values within the normal range
N.A.
:   not applicable because of motion artifacts
N.M.
:   not measured
N.P.
:   contrast-enhanced sequences were not performed
ONS
:   optic nerve sheath
STIR
:   short tau inversion recovery
T1WI
:   T1-weighted images
T2WI
:   T2-weighted images
TSE
:   turbo spin-echo
VP shunt
:   ventriculoperitoneal shunt" />
<meta name="DC.Contributor" content="A. Rohr" />
<meta name="DC.Contributor" content="U. Jensen" />
<meta name="DC.Contributor" content="C. Riedel" />
<meta name="DC.Contributor" content="A. van Baalen" />
<meta name="DC.Contributor" content="M.-C. Fruehauf" />
<meta name="DC.Contributor" content="T. Bartsch" />
<meta name="DC.Contributor" content="J. Hedderich" />
<meta name="DC.Contributor" content="L. Doerner" />
<meta name="DC.Contributor" content="O. Jansen" />
<meta name="article:published_time" content="2010-10-01" />
<meta name="article:section" content="Head and Neck" />
<meta name="citation_title" content="MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE: &lt;/h3&gt;
&lt;p&gt;Craniospinal hyper- or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS: &lt;/h3&gt;
&lt;p&gt;Nineteen patients with CSH were prospectively studied. Three readers assessed the width of the peri-optical CSF rim at 4 different anatomic positions by using coronal STIR sequences from a 3T MR imaging scanner. The height of the pituitary gland was also measured. Results were compared with normal values obtained with the same imaging technique. Qualitative signs of CSH also recorded were engorgement of venous sinuses, dural enhancement, subdural effusion, narrow ventricles, and sagging brain.&lt;/p&gt;&lt;h3&gt;RESULTS: &lt;/h3&gt;
&lt;p&gt;CSF signal intensity surrounding the optic nerves was diminished in at least 2 of the 4 positions used for measurements so that decreased diameters of the ONSs were observed in all patients (sensitivity, 100%; specificity, 97%). The height of the pituitary gland was above normal limits in 12 of 19 patients (sensitivity, 63%; specificity, 97%). Frequencies of qualitative signs of CSH varied from 32% to 81%.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS: &lt;/h3&gt;
&lt;p&gt;The ISSON in patients with CSH is partially or fully collapsed due to reduced CSF content. In comparison with other anatomic markers, this sign showed the highest sensitivity for the diagnosis of patients with CSH in this study.&lt;/p&gt;" />
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<meta name="twitter:title" content="MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/31/9.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Craniospinal hyper- or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.

MATERIALS AND METHODS: Nineteen patients with CSH were prospectively studied. Three readers assessed the width of the peri-optical CSF rim at 4 different anatomic positions by using coronal STIR sequences from a 3T MR imaging scanner. The height of the pituitary gland was also measured. Results were compared with normal values obtained with the same imaging technique. Qualitative signs of CSH also recorded were engorgement of venous sinuses, dural enhancement, subdural effusion, narrow ventricles, and sagging brain.

RESULTS: CSF signal intensity surrounding the optic nerves was diminished in at least 2 of the 4 positions used for measurements so that decreased diameters of the ONSs were observed in all patients (sensitivity, 100%; specificity, 97%). The height of the pituitary gland was above normal limits in 12 of 19 patients (sensitivity, 63%; specificity, 97%). Frequencies of qualitative signs of CSH varied from 32% to 81%.

CONCLUSIONS: The ISSON in patients with CSH is partially or fully collapsed due to reduced CSF content. In comparison with other anatomic markers, this sign showed the highest sensitivity for the diagnosis of patients with CSH in this study.

CI
:   confidence interval
CSH
:   craniospinal hypotension
FLAIR
:   fluid-attenuated inversion recovery
GRE
:   gradient-recalled echo
ICC
:   intraclass correlation coefficient
ISSON
:   intersheath space of the optic nerve
LP
:   lumbar puncture
MM
:   millimeter
MRI
:   MR imaging
MRV
:   3D phase-contrast MR venography
N
:   values within the normal range
N.A.
:   not applicable because of motion artifacts
N.M.
:   not measured
N.P.
:   contrast-enhanced sequences were not performed
ONS
:   optic nerve sheath
STIR
:   short tau inversion recovery
T1WI
:   T1-weighted images
T2WI
:   T2-weighted images
TSE
:   turbo spin-echo
VP shunt
:   ventriculoperitoneal shunt" />
<meta name="og-title" property="og:title" content="MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/9/1752" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Craniospinal hyper- or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.

MATERIALS AND METHODS: Nineteen patients with CSH were prospectively studied. Three readers assessed the width of the peri-optical CSF rim at 4 different anatomic positions by using coronal STIR sequences from a 3T MR imaging scanner. The height of the pituitary gland was also measured. Results were compared with normal values obtained with the same imaging technique. Qualitative signs of CSH also recorded were engorgement of venous sinuses, dural enhancement, subdural effusion, narrow ventricles, and sagging brain.

RESULTS: CSF signal intensity surrounding the optic nerves was diminished in at least 2 of the 4 positions used for measurements so that decreased diameters of the ONSs were observed in all patients (sensitivity, 100%; specificity, 97%). The height of the pituitary gland was above normal limits in 12 of 19 patients (sensitivity, 63%; specificity, 97%). Frequencies of qualitative signs of CSH varied from 32% to 81%.

CONCLUSIONS: The ISSON in patients with CSH is partially or fully collapsed due to reduced CSF content. In comparison with other anatomic markers, this sign showed the highest sensitivity for the diagnosis of patients with CSH in this study.

CI
:   confidence interval
CSH
:   craniospinal hypotension
FLAIR
:   fluid-attenuated inversion recovery
GRE
:   gradient-recalled echo
ICC
:   intraclass correlation coefficient
ISSON
:   intersheath space of the optic nerve
LP
:   lumbar puncture
MM
:   millimeter
MRI
:   MR imaging
MRV
:   3D phase-contrast MR venography
N
:   values within the normal range
N.A.
:   not applicable because of motion artifacts
N.M.
:   not measured
N.P.
:   contrast-enhanced sequences were not performed
ONS
:   optic nerve sheath
STIR
:   short tau inversion recovery
T1WI
:   T1-weighted images
T2WI
:   T2-weighted images
TSE
:   turbo spin-echo
VP shunt
:   ventriculoperitoneal shunt" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node10064--5" data-node-nid="10064" id="top-node-10064--6559571538" data-pisa="ajnr;31/9/1752" data-pisa-master="ajnr;ajnr.A2120" data-apath="/ajnr/31/9/1752.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Head and Neck</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">A. Rohr</span>, <span class="highwire-citation-author" data-delta="1">U. Jensen</span>, <span class="highwire-citation-author" data-delta="2">C. Riedel</span>, <span class="highwire-citation-author" data-delta="3">A. van Baalen</span>, <span class="highwire-citation-author" data-delta="4">M.-C. Fruehauf</span>, <span class="highwire-citation-author" data-delta="5">T. Bartsch</span>, <span class="highwire-citation-author" data-delta="6">J. Hedderich</span>, <span class="highwire-citation-author" data-delta="7">L. Doerner</span> and <span class="highwire-citation-author" data-delta="8">O. Jansen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1757; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2120 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-10064--6559571538" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">A. Rohr </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BRohr%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rohr%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.%2BRohr%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">U. 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<p id="p-2"><strong>BACKGROUND AND PURPOSE: </strong>Craniospinal hyper- or hypotension leads to morphologic changes in certain intracranial structures. We tested the hypothesis that the amount of CSF in the ONS visible in MR imaging is reduced in patients with CSH.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS: </strong>Nineteen patients with CSH were prospectively studied. Three readers assessed the width of the peri-optical CSF rim at 4 different anatomic positions by using coronal STIR sequences from a 3T MR imaging scanner. The height of the pituitary gland was also measured. Results were compared with normal values obtained with the same imaging technique. Qualitative signs of CSH also recorded were engorgement of venous sinuses, dural enhancement, subdural effusion, narrow ventricles, and sagging brain.</p>
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<p id="p-4"><strong>RESULTS: </strong>CSF signal intensity surrounding the optic nerves was diminished in at least 2 of the 4 positions used for measurements so that decreased diameters of the ONSs were observed in all patients (sensitivity, 100%; specificity, 97%). The height of the pituitary gland was above normal limits in 12 of 19 patients (sensitivity, 63%; specificity, 97%). Frequencies of qualitative signs of CSH varied from 32% to 81%.</p>
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<p id="p-5"><strong>CONCLUSIONS: </strong>The ISSON in patients with CSH is partially or fully collapsed due to reduced CSF content. In comparison with other anatomic markers, this sign showed the highest sensitivity for the diagnosis of patients with CSH in this study.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">CI<span class="def-item-dt-sep"></span></dt><dd>confidence interval<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CSH<span class="def-item-dt-sep"></span></dt><dd>craniospinal hypotension<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">FLAIR<span class="def-item-dt-sep"></span></dt><dd>fluid-attenuated inversion recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">GRE<span class="def-item-dt-sep"></span></dt><dd>gradient-recalled echo<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">ICC<span class="def-item-dt-sep"></span></dt><dd>intraclass correlation coefficient<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">ISSON<span class="def-item-dt-sep"></span></dt><dd>intersheath space of the optic nerve<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">LP<span class="def-item-dt-sep"></span></dt><dd>lumbar puncture<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">MM<span class="def-item-dt-sep"></span></dt><dd>millimeter<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">MRI<span class="def-item-dt-sep"></span></dt><dd>MR imaging<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">MRV<span class="def-item-dt-sep"></span></dt><dd>3D phase-contrast MR venography<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">N<span class="def-item-dt-sep"></span></dt><dd>values within the normal range<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">N.A.<span class="def-item-dt-sep"></span></dt><dd>not applicable because of motion artifacts<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">N.M.<span class="def-item-dt-sep"></span></dt><dd>not measured<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">N.P.<span class="def-item-dt-sep"></span></dt><dd>contrast-enhanced sequences were not performed<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">ONS<span class="def-item-dt-sep"></span></dt><dd>optic nerve sheath<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">STIR<span class="def-item-dt-sep"></span></dt><dd>short tau inversion recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-17">T1WI<span class="def-item-dt-sep"></span></dt><dd>T1-weighted images<span class="def-item-dd-sep"></span></dd><dt id="def-item-18">T2WI<span class="def-item-dt-sep"></span></dt><dd>T2-weighted images<span class="def-item-dd-sep"></span></dd><dt id="def-item-19">TSE<span class="def-item-dt-sep"></span></dt><dd>turbo spin-echo<span class="def-item-dd-sep"></span></dd><dt id="def-item-20">VP shunt<span class="def-item-dt-sep"></span></dt><dd>ventriculoperitoneal shunt</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/9/1752.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2010 </div></div>
      
      
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      <div class="highwire-cite-title">MR Imaging of the Optic Nerve Sheath in Patients with Craniospinal Hypotension</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1757; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2120 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Rohr</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">U.</span> <span class="nlm-surname">Jensen</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Riedel</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.</span> <span class="nlm-surname">van Baalen</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.-C.</span> <span class="nlm-surname">Fruehauf</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Bartsch</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hedderich</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Doerner</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">O.</span> <span class="nlm-surname">Jansen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1757; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2120 </span></div>
  
  
  
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