The diagnostic significance of large superior ophthalmic veins in patients with normal and increased intracranial pressure: CT and MR evaluation

Abstract

Objectives : To determine the normal size range of the superior ophthalmic veins (SOVs) and whether large SOVs are a reliable predictor of increased intracranial pressure (ICP). Materials and methods : The study consisted of two patient groups. Group one included 88 patients with no clinical evidence of increased ICP, who underwent screening sinus CT scans for uncomplicated sinusitis. The size of the SOVs was measured from these scans and the frequency of asymmetric SOVs was calculated. Group two included 10 patients with increased ICP proven by lumbar puncture (n = 8), ventriculostomy (n = 1), or strong clinical and radiologic findings (n = 1). Their imaging studies, which included CT scans, MR scans, and a cerebral angiogram, were reviewed retrospectively, and the size of the SOVs was correlated to ICP. Results : The 176 SOVs of the 88 patients from group one ranged from 1.4mm to 3.6mm, with a mean diameter of 2.2mm. Eighteen percent of the patients from group one had asymmetric SOVs. From group two, patients with mildly elevated ICP had SOVS that ranged from 2.0mm to 2.4mm, those with moderately increased ICP had SOVs that measured 1.4mm to 2.0mm, and those with severely increased ICP had a mean SOV size of 2.1mm. Conclusions : Dilated SOVs are occasionally seen in normal patients. This finding does not necessarily indicate that a lesion of the orbit or cavernous sinus is present. SOVs do not consistently dilate with increased ICP. Therefore, the size of the SOVs is a poor predictor of normal or increased ICP.