AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on February 26, 2009
doi: 10.3174/ajnr.A1498
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Relative Decrease in Signal Intensity of Subcortical White Matter in Spontaneous Intracranial Hypotension on Fluid-Attenuated Inversion Recovery Images

M. Adachia, S. Mugikurab, A. Shibatac, E. Kawaguchia, T. Satoa and S. Takahashib

a Department of Radiology, Ohshima Clinic, Yamagata, Japan
b Department of Radiology, Tohoku University School of Medicine, Sendai, Japan
c Division of Cancer Control, Yamagata Prefecture Medical Center for Cancer and Life-Style Related Disease, Yamagata, Japan


Figure 1
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  		Fig 1. A, A T1-weighted axial image from a 30-year-old woman (case 1) after administration of intravenous contrast media shows diffuse dural thickening and enhancement (arrows). B, A T2-weighted sagittal image from case 1 after administration of intravenous contrast media shows enlargement of the pituitary gland (white arrow), enlargement of the straight sinus (black arrow), and downward displacement of the brain or "sagging brain" associated with flattening of the pons with obliteration of the prepontine cistern (arrowheads), indicating a diagnosis of SIH.


Figure 2
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  		Fig 2. A, A FLAIR image from case 1 demonstrates the regions of interest to measure the signal intensity set in the subcortical white matter and adjacent cortex in the middle frontal gyrus and inferior parietal lobule. B, A FLAIR image from case 1 demonstrates the region of interest to measure the signal intensity set in the corpus callosum (splenium).


Figure 3
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  		Fig 3. A, A pretreatment FLAIR image obtained from case 1 when the symptoms were intense shows that the signal intensity of the subcortical white matter is apparently lower than that of the cortex, with the border between them being readily distinguishable (arrows). B, A follow-up FLAIR image obtained from case 1 when the symptoms improved shows that the signal intensity of the subcortical white matter has become less distinct from that of the cortex.


Figure 4
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  		Fig 4. A, A receiver operating characteristic (ROC) curve in the control group and pretreatment images in patients with SIH. B, An ROC curve in the control group and follow-up images in patients with SIH. C, An ROC curve in pretreatment and follow-up images in patients with SIH.


Figure 5
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  		Fig 5. A pretreatment T2-weighted image from case 1 (A) and a follow-up T2-weighted image when the symptoms of SIH resolved (B). Signal intensity alteration of the subcortical white matter is not visually appreciable between pretreatment and follow-up T2-weighted images, though a small amount of subdural effusion seen on the pretreatment image has resolved on the follow-up image.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X