MRI findings of spontaneous intracranial hypotension: Usefulness of straight sinus distention

OBJECTIVE. Spontaneous intracranial hypotension (SIH) shows various characteristic MRI findings. We evaluated the usefulness of straight sinus distention compared with transverse sinus distention and also evaluated other MRI findings of SIH. MATERIALS AND METHODS. Forty-three consecutive patients (28 female and 15 male patients) treated for SIH and 43 age- and sex-matched control subjects at two institutions from 2012 through 2014 were included in this study. Two reviewers determined whether the transverse sinus distention sign and straight sinus distention sign were present on MRI. Diagnostic performance values and interobserver agreement were calculated. Reviewers also assessed MRI examinations in consensus for the presence of the following findings: pachymeningeal enhancement, subdural effusion or hematoma, enlargement of the pituitary gland, and downward displacement of the brainstem and tonsils. RESULTS. The sensitivity, specificity, and diagnostic accuracy of the transverse sinus distention sign for SIH were 76.7%, 83.7%, and 80.2%, whereas those of the straight sinus distention sign were 79.1%, 95.4%, and 87.2%, respectively. The specificity of the straight sinus distention sign for SIH was significantly higher (p = 0.025) than that of the transverse sinus distention sign. In addition, the straight sinus distention sign showed substantial agreement (κ = 0.79), whereas the transverse sinus distention sign showed moderate agreement (κ = 0.60). The diagnostic accuracy of the presence of either transverse or straight sinus distention (83.7%) was significantly higher than that of pachymeningeal enhancement (80.2%, p = 0.032). CONCLUSION. The straight sinus distention sign could be helpful for the diagnosis of SIH because it has sensitivity comparable to other imaging findings and higher specificity and higher level of interobserver agreement than other imaging findings.