Relative Decrease in Signal Intensity of Subcortical White Matter in Spontaneous Intracranial Hypotension on Fluid-Attenuated Inversion Recovery Images

Abstract

In reviewing MR images of patients with spontaneous intracranial hypotension (SIH), we found an accentuated decrease in the subcortical white matter on fluid-attenuated inversion recovery (FLAIR) images. Our aim was to determine whether the signal intensity of the subcortical white matter decreases on FLAIR and T2-weighted images in SIH. We retrospectively examined pretreatment MR images including 7 FLAIR and 10 T2-weighted images obtained from 10 patients with SIH and follow-up images (5 FLAIR and 7 T2-weighted images). Two observers measured the signal intensities in the subcortical white matter on MR images at the level of the centrum semiovale and, to calculate the signal intensity ratios, measured those of the adjacent cortex and corpus callosum. Furthermore, 4 observers performed visual evaluation for accentuated signal intensity decreases for receiver operating characteristic (ROC) analysis. The intensity ratios of the subcortical white matter, both to the adjacent cortex and corpus callosum, were significantly different between the control and pretreatment images in SIH and between pretreatment and follow-up images in SIH on FLAIR images, whereas these showed no significant differences between the control and follow-up images in SIH. On visual inspection, an accentuated decrease in signal intensity in the subcortical white matter was shown on pretreatment FLAIR images, which returned to the control level on follow-up images. However, on the T2-weighted images we could hardly recognize the decrease in the signal intensity. Awareness of the decreased signal intensity of the subcortical white matter on FLAIR images could help in the diagnosis of SIH.