title: Imaging Signs in Spontaneous Intracranial Hypotension: Prevalence and Relationship to CSF Pressure.
abstract: Patients with spontaneous intracranial hypotension often exhibit low CSF pressure and changes on brain MR imaging and/or evidence of CSF leak on myelography. We investigated whether individual imaging signs of spontaneous intracranial hypotension correlate with measured CSF pressure and how frequently these 2 markers of spontaneous intracranial hypotension were concordant.
  
  
  
  We performed a retrospective, cross-sectional study of 99 subjects with spontaneous intracranial hypotension. Prevalence of brain and myelographic imaging signs of spontaneous intracranial hypotension was recorded. CSF pressure among subjects with or without individual imaging signs was compared by using a 2-tailed t test and ANOVA. Concordance between low CSF pressure (≤6 cm H2O) and imaging was defined as the presence of the sign in a subject with low CSF pressure or absence of the sign when pressure was not low.
  
  
  
  Dural enhancement, brain sagging, and venous distension sign were present in 83%, 61%, and 75% of subjects, respectively, and myelographic evidence of CSF leak was seen in 55%. Marginal correlations between CSF pressure and brain sagging (P = .046) and the venous distension sign (P = .047) were found. Dural enhancement and myelographic evidence of leak were not significantly correlated with CSF pressure. Rates of concordance between imaging signs and low CSF pressure were generally low, ranging from 39% to 55%.
  
  
  
  Brain and myelographic signs of spontaneous intracranial hypotension correlate poorly with CSF pressure. These findings reinforce the need to base the diagnosis of spontaneous intracranial hypotension on multiple diagnostic criteria and suggest the presence of patient-specific variables that influence CSF pressure in these individuals.
authors: From the Department of Radiology, Duke University Medical Center, Durham, North Carolina. peter.kranz@duke.edu.
authors: P G
authors: 0000-0001-5410-7135
authors: PG
authors: Kranz
authors: From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors: T P
authors: 0000-0002-5283-8767
authors: TP
authors: Tanpitukpongse
authors: From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors: K R
authors: 0000-0002-0306-2915
authors: KR
authors: Choudhury
authors: From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors: T J
authors: 0000-0002-9354-9486
authors: TJ
authors: Amrhein
authors: From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors: L
authors: 0000-0002-5401-9343
authors: L
authors: Gray
mesh_terms: D000328:Adult; D015170:Cerebrospinal Fluid Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods; D059906:Neuroimaging / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies