RT Journal Article SR Electronic T1 Quantitative Measurement of CSF in Patients with Spontaneous Intracranial Hypotension JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1061 OP 1067 DO 10.3174/ajnr.A5134 VO 38 IS 5 A1 H.-C. Chen A1 P.-L. Chen A1 Y.-H. Tsai A1 C.-H. Chen A1 C.C.-C. Chen A1 J.-W. Chai YR 2017 UL http://www.ajnr.org/content/38/5/1061.abstract AB BACKGROUND AND PURPOSE: CSF hypovolemia is a core feature of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is characterized by orthostatic headache and radiologic manifestations, including CSF along the neural sleeves, diffuse pachymeningeal enhancement, and/or venous engorgement. However, these characteristics are only qualitative. Quantifying intraspinal CSF volumes could improve spontaneous intracranial hypotension diagnosis and evaluation of hypovolemic statuses in patients with spontaneous intracranial hypotension. The purpose of this study was to compare intraspinal CSF volumes across spontaneous intracranial hypotension stages and to test the clinical applicability of these measures.MATERIALS AND METHODS: A cohort of 23 patients with spontaneous intracranial hypotension and 32 healthy controls was subjected to brain MR imaging and MR myelography with 1.5T imaging. An automatic threshold-based segmentation method was used to calculate intraspinal CSF volumes at initial hospitalization (spontaneous intracranial hypotension-initial), partial improvement (spontaneous intracranial hypotension-intermediate), and complete recovery (spontaneous intracranial hypotension-recovery) stages.RESULTS: The mean intraspinal CSF volumes observed were the following: 95.31 mL for healthy controls, 72.31 mL for spontaneous intracranial hypotension-initial, 81.15 mL for spontaneous intracranial hypotension-intermediate, and 93.74 mL for spontaneous intracranial hypotension-recovery. Increased intraspinal CSF volumes were related to disease recovery (P < .001). The intraspinal CSF volumes of patients before complete recovery were significantly lower than those of healthy controls. With the estimated intradural CSF volumes as a reference, the intraspinal CSF volume percentage was lower in patients with spontaneous intracranial hypotension with venous engorgement than in those without it (P = .058).CONCLUSIONS: With a threshold-based segmentation method, we found that spinal CSF hypovolemia is fundamentally related to spontaneous intracranial hypotension. Intraspinal CSF volumes could be a sensitive parameter for the evaluation of treatment response and follow-up monitoring in patients with spontaneous intracranial hypotension.BHbody heightBMIbody mass indexBWbody weight3D-SPACE3D sampling perfection with application-optimized contrasts by using different flip angle evolutionECSFestimated intradural CSF volumeDPEdiffuse pachymeningeal enhancementHChealthy controlMRMMR myelographySIHspontaneous intracranial hypotension