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DOI: 10.1055/s-2008-1027627
© Georg Thieme Verlag KG Stuttgart · New York
Pseudotumor cerebri: Quantitative Normalwerte anatomischer Kennstrukturen im kraniellen MRT
Pseudotumor Cerebri: Quantitative In-Vivo Measurements of Markers of Intracranial HypertensionPublikationsverlauf
eingereicht: 8.5.2008
angenommen: 6.6.2008
Publikationsdatum:
08. September 2008 (online)
![](https://www.thieme-connect.de/media/roefo/200810/lookinside/thumbnails/10.1055-s-2008-1027627-1.jpg)
Zusammenfassung
Ziel: Eine intrakranielle Druckerhöhung kann zu Veränderungen an anatomischen Strukturen führen, deren Kenntnis Voraussetzung einer erfolgreichen MR-Diagnostik beim Pseudotumor cerebri ist. Ziel der Untersuchung war, quantitative Normalwerte kritischer Strukturen zu bestimmen und deren Abhängigkeit von Geschlecht, Alter und Body-Mass-Index (BMI) zu ermitteln. Material und Methoden: 123 Personen ohne Hinweis auf eine intrakranielle Hypertension (63 Frauen, 60 Männer, 18 – 86 Jahre, MW 49,5 ± 17,8 Jahre, durchschnittlicher BMI 25,3 ± 4,2) wurden prospektiv eingeschlossen. Anhand einer kraniellen 3T-MRT (koronare STIR-Sequenz) wurde der Durchmesser des N. opticus, der Optikusscheide und des perineuralen Liquorsaums an 4 intraorbitalen Positionen vermessen, Höhe und Breite der Hypophyse und des Cavum Meckeli bestimmt und die Fläche errechnet. Ergebnisse: Die Weite der Optikusscheide nahm von ventral nach dorsal signifikant von im Mittel 5,3 ± 0,6 mm auf 4,1 ± 0,4 mm ab, sodass die Messposition bei Vergleichsmessungen zu berücksichtigen ist. Ähnliches gilt für den perineuralen Liquorsaum (MW 1,4 ± 0,3 mm vs. 1,0 ± 0,2 mm) und in geringem Maße für den Sehnerven selbst (MW 2,4 ± 0,4 mm vs. 2 ± 0,3 mm, p jeweils < 0,001). Die Weite der Optikusscheide korrellierte geringfügig mit dem Alter (r = 0,199), dies war aber statistisch nicht signifikant. Die koronar gemessene Fläche des Cavum Meckeli war unabhängig von Geschlecht, Alter und BMI und betrug im Mittel 39 ± 9,3 mm2. Die Höhe der Hypophyse unterschied sich bei Frauen (MW 4,4 ± 0,9 mm) und Männern (MW 4,2 ± 0,8 mm) im Mittel nur gering, allerdings nahm die Höhe bei Frauen im Gegensatz zu Männern im Alter signifikant ab (r = –0,38, p = 0,01). Schlussfolgerung: Die hier präsentierten Normalwerte sind Ausgangspunkt für die Bestimmung pathologischer Veränderungen bei Patienten mit V. a. Pseudotumor cerebri.
Abstract
Purpose: Intracranial hypertension can change the morphology of anatomical structures that are critical in the evaluation of pseudotumor syndromes. The purpose of our study was to establish the normal range of such markers of intracranial hypertension and to consider a dependency on sex, age and body-mass index (BMI). Materials and Methods: 123 persons without signs or symptoms of intracranial hypertension (63 females, 60 males, 18 – 86 years old, mean 49.5 SD 17.8 years, mean BMI 25.3 SD 42) were prospectively enrolled and MRI was performed at 3T. A STIR sequence in the coronal plane was used to measure the width of the optic nerve, the perioptic fluid rim and the total optic nerve sheath diameter in 4 different locations behind the eyeball. The height and width of the pituitary and Meckel’s cave were also measured and the area was calculated. Results: The mean width of the optic nerve sheath narrows significantly from anterior (mean 5.3 SD 0.6 mm) to posterior (mean 4.1 SD 0.4 mm), as does the perioptic fluid rim (mean 1.4 SD 0.3 mm vs. mean 1.0 SD 0.2 mm) and – to a lesser extent – the optic nerve itself (mean 2.4 SD 0.4 mm vs. mean 2 SD 0.3 mm, p = 0.000 for all). There was no statistically relevant correlation of the width of the optic nerve sheath with age. The coronal area of Meckel’s cave was independent of sex, age or BMI (mean 39 SD 9.3 mm2). The height of the pituitary differed little in women (mean 4.4 SD 0.9 mm) and men (mean 4.2 SD 0.8 mm), but we found a significant negative correlation with age in women only (r = –0.38, p = 0.01). Conclusion: The presented typical values and their deviations serve as a basis for the evaluation of pathologies in patients suspected of having pseudotumor syndrome.
Key words
pseudotumor cerebri - pituitary - MR imaging - orbit - intracranial hypertension
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Dr. Axel Rohr
Neuroradiologie, UK-SH Campus Kiel
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