title: Magnetic resonance imaging finding of empty sella in obesity related idiopathic intracranial hypertension is associated with enlarged sella turcica.
abstract: BACKGROUND
  Empty sella in MRI is an important finding associated with idiopathic intracranial hypertension (IIH). This study assesses the sensitivity and reproducibility of several morphological measures of the sella and pituitary gland to indentify the measure that best differentiates IIH from controls. Additionally, the study assesses reversal in gland compression following treatment.
  
  
  METHODS
  Sagittal 3D-T1W sequence with 1 mm isotropic resolution was obtained from ten newly diagnosed IIH patients and 11 matched healthy controls. Follow-up MRI scans were obtained from eight patients at 1-week post-lumbar puncture and acetazolamide treatment. 1D and 2D measures of absolute and normalized heights and cross-sectional areas of the gland and sella were obtained to identify the measure that best differentiates IIH patients and controls.
  
  
  RESULTS
  Overall area-based measurements had higher sensitivity than length with p < 0.0001 for sella area compared with p = 0.004 for normalized gland height. The gland cross-sectional areas were similar in both cohorts (p = 0.557), while the sella area was significantly larger in IIH, 200 ± 24 versus 124 ± 25 mm(2), with the highest sensitivity and specificity, 100% and 90.9%, respectively. Absolute gland area was the most sensitive measure for assessing post treatment changes, with 100% sensitivity and 50 % specificity. Average post-treatment gland area was 18% larger (p = 0.016). Yet, all eight patients remained within the empty sella range based on a normalized gland area threshold of 0.41.
  
  
  CONCLUSIONS
  Sellar area is larger in IIH, and it demonstrated highest sensitivity for differentiating IIH from control subjects, while absolute gland area was more sensitive for detecting post treatment changes.
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Ranganathan
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA.
authors.forename: Sang H
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Checkver
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sklar
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Danton
authors.affiliation: Department of Radiology, University of Miami, Miami, FL, USA. nalperin@med.miami.edu.|Department of Radiology, Professional Arts Center, University of Miami Leonard M. Miller School of Medicine, 1150 NW 14th Street, Suite 713 (M-869), Miami, FL, 33136, USA. nalperin@med.miami.edu.
authors.forename: Noam
authors.initials: N
authors.lastname: Alperin
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D000328:Adult; D004232:Diuretics / Q000652:urine; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011559:Pseudotumor Cerebri / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology*; D015203:Reproducibility of Results; D012658:Sella Turcica / Q000187:drug effects / Q000473:pathology*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D000086:Acetazolamide