Dynamic MR imaging in Tolosa-Hunt syndrome.
OBJECTIVE
To evaluate the cavernous sinuses with dynamic magnetic resonance (MR) imaging in patients with Tolosa-Hunt syndrome (THS).


METHODS
The sellar and parasellar regions of five patients with THS and 12 control subjects were examined with dynamic MR (1.5 T) imaging in the coronal plane. Dynamic images were obtained with spin-echo (SE) sequences in three patients, and with fast spin-echo (FSE) sequences in two patients and control subjects. Conventional MR images of the cranium including sellar and parasellar regions were also obtained on T1-weighted pre- and post-contrast SE, and T2-weighted FSE sequences in the coronal plane.


RESULTS
MR images revealed affected cavernous sinus with bulged convex lateral wall in three patients and concave lateral wall in two patients. In all control subjects, cavernous sinuses were observed with concave lateral wall. The signal intensity on T1- and T2-weighted images and contrast enhancement on post-contrast images of the affected cavernous sinuses in patients were similar to those of the unaffected cavernous sinuses in patients and control subjects. The dynamic images in all patients disclosed small areas adjacent to the cranial nerve filling-defects within the enhanced venous spaces of the affected cavernous sinus, which showed slow and gradual enhancement from the early to the late dynamic images. No such gradually enhancing area was observed in control subjects except one. The follow-up dynamic MR images after corticosteroid therapy revealed complete resolution of the gradually enhancing areas in the previously affected cavernous sinus.


CONCLUSIONS
Dynamic MR imaging may facilitate the diagnosis of THS.
Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Hospital, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, 606-8507, Japan.
Tabassum Laz
TL
Haque
Yukio
Y
Miki
Satoshi
S
Kashii
Akira
A
Yamamoto
Mitsunori
M
Kanagaki
Takahiro
T
Takahashi
Yasutaka
Y
Fushimi
Reinin
R
Asato
Nagako
N
Murase
Hiroshi
H
Shibasaki
Junji
J
Konishi
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002426:Cavernous Sinus / Q000187:drug effects / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA / Q000008:administration & dosage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010902:Pituitary Gland / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D005938:Glucocorticoids; C064925:gadodiamide; D011239:Prednisolone; D019786:Gadolinium DTPA; D008775:Methylprednisolone