Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension

A–C, Transverse sinus stenosis on coronal T1 postgadolinium MR imaging. A and B, Images from a 43-year-old female patient with idiopathic intracranial hypertension. CSF opening pressure was 380 mm H₂O. Postgadolinium coronal 3D fast-spoiled gradient recalled images, section thickness = 2.4 mm, demonstrate stenosis of the transverse sinuses bilaterally (arrows). The expected Δ configuration is distorted and collapsed bilaterally (A). This is more easily appreciated on images from within the same study by comparing with the images of the same sinuses more posteriorly (B). C and D, Images from a 36-year-old female patient with IIH. CSF opening pressure was 370 mm H₂O. Postgadolinium T1-weighted image (C) with coronal reformatting from a 3D acquisition, with a section thickness = 2 mm, TR = 650 ms, TE = 12 ms; and oblique projectional image from a gadolinium-bolused MRV sequence, with TR = 3.83 ms and TE = 1.39 ms. Stenoses of the transverse sinuses are evident on both images (arrows). E and F, Coronal T1-weighted image from a 32-year-old female patient with IIH. CSF opening pressure was 304 mm H₂O. Virtually complete collapse of the transverse sinuses can be discerned bilaterally (arrows). A sagittal raw data image (F) from the gadolinium-bolused MRV, section thickness = 0.66 mm, suggests an appearance of herniation of the temporo-occipital tissues into the transverse sinus space. G, By contrast, an image from a control patient, a 49-year-old woman with multiple medical problems but no specific explanation for her symptoms of headache. A coronal postgadolinium T1-weighted image, section thickness = 4 mm, shows the expected Δ configuration (arrows) of the preserved transverse sinuses bilaterally.