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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1489-1493, September 2007
DOI 10.3174/ajnr.A0621
© 2007 American Society of Neuroradiology

BRAIN

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

R.I. Farb^a, R. Forghani^b, S.K. Lee^a, D.J. Mikulis^a and R. Agid^a

^a From the Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
^b Department of Medical Imaging, McGill University, Montreal, Quebec, Canada

Please address correspondence to Richard I. Farb, Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto Western Hospital, New East Wing 3MC 430, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; e-mail: richard.farb{at}utoronto.ca

BACKGROUND AND PURPOSE: Patients with intracranial hypotension (IH) demonstrate intracranial venous enlargement with a characteristic change in contour of the transverse sinus seen on routine T1-weighted sagittal imaging. In IH, the inferior margin of the midportion of the dominant transverse sinus acquires a distended convex appearance; we have termed this the venous distension sign (VDS). This is distinct from the normal appearance of this segment, which usually has a slightly concave or straight lower margin. This sign is introduced, and its performance as a test for the presence of this disease is evaluated.

MATERIALS AND METHODS: The transverse sinuses on T1-weighted sagittal imaging of 15 patients with IH and 15 control patients were independently assessed in a blinded fashion by 3 readers for the presence of a VDS. A present or absent VDS was determined for each patient by each reader, and a consensus result for each patient was determined by unanimity or majority rule.

RESULTS: Using the VDS, the readers correctly identified 93% (14 of 15) of the IH patients and similarly 93% (14 of 15) of the control patients. There was a high rate of agreement among the readers for the interpretation of the VDS (multirater = 0.82). The overall sensitivity of the VDS for the diagnosis of intracranial hypotension was 94%. Specificity was also 94%.

CONCLUSION: The VDS appears to be an accurate test for the presence or absence of IH and may be helpful in the evaluation of these patients.

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