From the Guidelines
The latest research on MRV for IIH suggests that it plays a crucial role in evaluating venous sinus stenosis, which is commonly associated with IIH, and can help select patients who may benefit from venous sinus stenting, as reported in the 2018 consensus guidelines on management of IIH 1. The current role of MRV in IIH is to detail anatomical abnormalities of the cerebral venous sinus system, including stenosis of the dominant or both transverse sinus, which may result from intrinsic dural sinus anatomy or extrinsic compression by the increased intracranial pressure. Some key points to consider when using MRV for IIH include:
- Improvements in venography imaging now detail that many with IIH have anatomical abnormalities of the cerebral venous sinus system, including stenosis of the dominant or both transverse sinus 1.
- The degree of stenosis does not appear to uniformly correlate with intracranial pressure or visual loss, highlighting the importance of individualized assessment and treatment planning 1.
- Neurovascular stenting has been reported to lead to an improvement in symptoms of intracranial hypertension, but the role of neurovascular stenting in IIH is not yet established, and long-term antithrombotic therapy is required for longer than 6 months following treatment 1. When ordering an MRV for IIH patients, clinicians should consider the latest techniques, including high-resolution 3D MRV protocols and quantitative flow measurements, to better visualize the venous structures and assess hemodynamic changes. The use of contrast-enhanced MRV appears to be superior to non-contrast techniques for detecting subtle stenoses, particularly in the transverse and sigmoid sinuses. Post-treatment MRV is valuable for monitoring stent patency and venous flow improvements, and can help guide further management and treatment decisions.
From the Research
Latest Research on MRV for IIH
- The latest research on MRV (Magnetic Resonance Venography) for IIH (Idiopathic Intracranial Hypertension) suggests that venous sinus stenosis is a significant contributor to the pathophysiology of IIH 2.
- A study published in 2023 found that stenting of the venous sinus can lead to significant improvements in symptoms, including resolution of transient visual obscurations, pulsatile tinnitus, and diplopia, as well as improvement in headaches and papilledema 2.
- Another study published in 2020 highlighted the importance of imaging in the diagnosis of IIH, including the use of MRV to detect venous sinus stenosis 3.
- A review published in 2022 discussed the complex role of venous sinus stenosis in IIH and the potential mechanisms underlying this condition, including the use of venous manometry to evaluate the pressure gradient 4.
- A study published in 2021 evaluated the diagnosis and management approaches of neurologists for IIH and found that younger neurologists were more likely to recognize neuro-radiologic findings, including flattening of the posterior aspect of the globe and tortuosity of the optic nerve 5.
- A review published in 2017 discussed the use of venous sinus stenting for IIH and highlighted the need for prospective, controlled trials to confirm its efficacy and safety 6.
Key Findings
- Venous sinus stenosis is a significant contributor to the pathophysiology of IIH 2, 3, 4.
- Stenting of the venous sinus can lead to significant improvements in symptoms, including resolution of transient visual obscurations, pulsatile tinnitus, and diplopia, as well as improvement in headaches and papilledema 2.
- Imaging, including MRV, plays a crucial role in the diagnosis of IIH 3, 5.
- Venous manometry can be used to evaluate the pressure gradient in IIH 4.
- Prospective, controlled trials are needed to confirm the efficacy and safety of venous sinus stenting for IIH 6.