title: Magnetic resonance imaging biomarkers indicate a central venous hypertension syndrome in patients with symptomatic pineal cysts.
abstract: BACKGROUND
  While most pineal cysts (PCs) are asymptomatic, some PCs are accompanied with symptoms of variable severity. We suggested that symptom severity in symptomatic patients with non-hydrocephalic PCs relates to venous compression causing central venous hypertension. This study explored whether possible magnetic resonance imaging (MRI) biomarkers of central venous hypertension could differentiate the severity of symptoms in individuals with non-hydrocephalic PCs.
  
  
  METHODS
  The study included all individuals with PCs and MRI available for analysis followed conservatively within the department from 2003 to 2014. Severity of symptoms at follow-up were assessed from a questionnaire. Suggested MRI biomarkers indicative of central venous hypertension were explored, in addition to MRI measures of cyst size, aqueduct stenosis, and tectal compression.
  
  
  RESULTS
  The study included 66 patients. As compared to the 27/66 patients (41%) with "None-Moderate" symptoms at follow-up, the 39/66 patients (59%) with "Much-Severe" symptoms presented with significantly altered indices of central venous hypertension (tectum-splenium-cyst ratio and indices of thalamic and periventricular edema). PC grading based on MRI biomarkers of central venous hypertension differentiated the severity of symptoms.
  
  
  CONCLUSIONS
  The results indicate an association between severity of symptoms and MRI biomarkers of central venous hypertension in symptomatic individuals with non-hydrocephalic PCs.
authors.affiliation: Dept. of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: p.k.eide@medisin.uio.no.
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Eide
authors.affiliation: Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Are Hugo
authors.initials: AH
authors.lastname: Pripp
authors.affiliation: Dept. of Radiology and Nuclear Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Geir A
authors.initials: GA
authors.lastname: Ringstad
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism; D020863:Central Nervous System Cysts / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism; D002496:Central Venous Pressure; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010871:Pinealoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism
keywords: Central venous hypertension; Clinical outcome; MRI; Pineal cysts; Symptomatic