Neurosurgical focus · 2026
MRI evaluation of pituitary/sella turcica ratio and venoglymphatic congestion in idiopathic intracranial hypertension.
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Finkelstein Alan J, Schartz Derrek, Mendoza-Ayus Santiago, Bender Matthew T
Аннотация
OBJECTIVE: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without an identifiable cause, commonly affecting young obese women. While transverse sinus stenosis (TSS) and empty sella are frequent radiological findings in IIH, the relationship between the severity of empty sella and the extent of TSS remains poorly understood.
METHODS: In this retrospective study, authors analyzed patients with IIH diagnosed by established criteria in 2013-2023 and healthy controls matched for age, sex, and BMI. All patients underwent 3T brain MRI with contrast-enhanced T1-weighted sequences and MR venography within 3 months of IIH diagnosis. Volumetric analysis was performed using FreeSurfer software. Pituitary and sella turcica areas were manually segmented on midsagittal T1-weighted images, and the pituitary/sella turcica (PS) ratio was calculated. TSS severity was assessed using the Farb scoring system (0-8, with lower scores indicating greater stenosis). Statistical analysis included linear regression and receiver operating characteristic (ROC) curve analysis.
RESULTS: Patients with IIH (n = 69) demonstrated a significantly lower pituitary volume (48.9 vs 63.3 mm2, p = 0.0023), larger sella turcica area (116 vs 73.1 mm2, p < 0.0001), and reduced PS ratio (0.44 vs 0.86, p < 0.0001) compared to those in healthy controls (n = 15). A significant association was found between a declining PS ratio and increasing TSS severity (R = 0.26, p = 0.03) and normalized total brain volume (R = 0.24, p = 0.044). ROC analysis revealed that the PS ratio had 92.8% sensitivity and 100% specificity in differentiating patients with IIH from healthy controls (area under the curve = 0.981).
CONCLUSIONS: The PS ratio correlates significantly with TSS severity and brain volume in patients with IIH, suggesting that both findings reflect CSF and interstitial fluid dyshomeostasis. The PS ratio is highly sensitive and specific for IIH and may serve as a noninvasive imaging biomarker for assessing the severity of venous sinus stenosis and intracranial pressure elevation in IIH, particularly useful in settings where MR venography is unavailable. Further research is needed to explore the causative relationship between venous stenosis and empty sella formation.
METHODS: In this retrospective study, authors analyzed patients with IIH diagnosed by established criteria in 2013-2023 and healthy controls matched for age, sex, and BMI. All patients underwent 3T brain MRI with contrast-enhanced T1-weighted sequences and MR venography within 3 months of IIH diagnosis. Volumetric analysis was performed using FreeSurfer software. Pituitary and sella turcica areas were manually segmented on midsagittal T1-weighted images, and the pituitary/sella turcica (PS) ratio was calculated. TSS severity was assessed using the Farb scoring system (0-8, with lower scores indicating greater stenosis). Statistical analysis included linear regression and receiver operating characteristic (ROC) curve analysis.
RESULTS: Patients with IIH (n = 69) demonstrated a significantly lower pituitary volume (48.9 vs 63.3 mm2, p = 0.0023), larger sella turcica area (116 vs 73.1 mm2, p < 0.0001), and reduced PS ratio (0.44 vs 0.86, p < 0.0001) compared to those in healthy controls (n = 15). A significant association was found between a declining PS ratio and increasing TSS severity (R = 0.26, p = 0.03) and normalized total brain volume (R = 0.24, p = 0.044). ROC analysis revealed that the PS ratio had 92.8% sensitivity and 100% specificity in differentiating patients with IIH from healthy controls (area under the curve = 0.981).
CONCLUSIONS: The PS ratio correlates significantly with TSS severity and brain volume in patients with IIH, suggesting that both findings reflect CSF and interstitial fluid dyshomeostasis. The PS ratio is highly sensitive and specific for IIH and may serve as a noninvasive imaging biomarker for assessing the severity of venous sinus stenosis and intracranial pressure elevation in IIH, particularly useful in settings where MR venography is unavailable. Further research is needed to explore the causative relationship between venous stenosis and empty sella formation.