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Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension.

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Title: Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension.
Authors: Knievel, Kerry, Alhilali, Lea, Mushtaq, Raza, McCormick, Kelly, Stancl, Rachel, Secora, Karissa, Robblee, Jennifer
Source: Headache: The Journal of Head & Face Pain. Sep2025, Vol. 65 Issue 8, p1394-1402. 9p.
Subjects: Diagnosis of brain diseases, Cross-sectional method, Statistical power analysis, Body mass index, Receiver operating characteristic curves, Research funding, T-test (Statistics), Data analysis, Cerebrospinal fluid leak, Scientific observation, Brain diseases, Magnetic resonance imaging, Chi-squared test, Descriptive statistics, Longitudinal method, Connective tissue diseases, Lumbar vertebrae, Statistics, Comparative studies, Data analysis software, Confidence intervals, Sensitivity & specificity (Statistics)
Abstract: Objectives/Background: This study was undertaken to determine whether thecal sac volume and morphometry can be used to differentiate patients with spontaneous intracranial hypotension (SIH). The mechanisms underlying SIH appear to be multifactorial. Association with connective tissue disorders is established, suggesting that increased thecal sac compliance and volume may contribute to SIH. Methods: This study is an observational cross‐sectional study that used magnetic resonance imaging (MRI) to compare thecal sac volume between patients with SIH and healthy controls. Patients with SIH and matched controls were prospectively recruited from December 1, 2020 to March 1, 2022. All participants underwent volumetric MRI of the entire spine. Semiautomated segmentation was used to extract three‐dimensional volumetric models of the thecal sac. A single average thecal sac model was created for each group. Signed model to model distance function was used to compute and visualize the correspondent vectors that quantify the localized differences, including shape, between control and SIH thecal sacs. Results: Twenty‐eight patients with SIH (mean age = 45.9 years, mean body mass index = 27.7, 57% male) and 28 controls (mean age = 44.4 years, mean body mass index = 26.8, 57% male) were recruited. The thecal sac was significantly larger in patients with SIH (mean = 131.7 cm3, 95% confidence interval [CI] = 108.1–155.3) than controls (mean = 116.5 cm3, 95% CI = 105.1–127.9, p < 0.001). Thecal sac volume demonstrated excellent discrimination for SIH (area under the curve = 0.91, 95% CI = 0.83–0.98, p < 0.001). Volume > 122 cm3 was 82% sensitive and 82% specific for SIH; volume > 126 cm3 was 100% specific. Regional thoracic volume was slightly higher in patients with SIH (61.6 and 57.8 cm3, respectively, p = 0.020), and lumbar volume was notably higher (46.6 and 33.0 cm3, respectively, p < 0.001). Conclusion: Patients with SIH have a significantly larger thecal sac than controls, which can be an effective tool to diagnose these patients. Plain Language Summary: This study examined whether the size and shape of the fluid‐filled space around the spinal cord, called the thecal sac, could help diagnose spontaneous intracranial hypotension (SIH), a condition with low spinal fluid volume, from leaking spinal fluid. Using spinal magnetic resonance imaging scans from 28 patients with SIH and 28 controls, we found that people with SIH had significantly larger thecal sacs than those without the condition. These volume differences could help doctors more accurately identify SIH using noninvasive MRI. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Objectives/Background: This study was undertaken to determine whether thecal sac volume and morphometry can be used to differentiate patients with spontaneous intracranial hypotension (SIH). The mechanisms underlying SIH appear to be multifactorial. Association with connective tissue disorders is established, suggesting that increased thecal sac compliance and volume may contribute to SIH. Methods: This study is an observational cross‐sectional study that used magnetic resonance imaging (MRI) to compare thecal sac volume between patients with SIH and healthy controls. Patients with SIH and matched controls were prospectively recruited from December 1, 2020 to March 1, 2022. All participants underwent volumetric MRI of the entire spine. Semiautomated segmentation was used to extract three‐dimensional volumetric models of the thecal sac. A single average thecal sac model was created for each group. Signed model to model distance function was used to compute and visualize the correspondent vectors that quantify the localized differences, including shape, between control and SIH thecal sacs. Results: Twenty‐eight patients with SIH (mean age = 45.9 years, mean body mass index = 27.7, 57% male) and 28 controls (mean age = 44.4 years, mean body mass index = 26.8, 57% male) were recruited. The thecal sac was significantly larger in patients with SIH (mean = 131.7 cm3, 95% confidence interval [CI] = 108.1–155.3) than controls (mean = 116.5 cm3, 95% CI = 105.1–127.9, p &lt; 0.001). Thecal sac volume demonstrated excellent discrimination for SIH (area under the curve = 0.91, 95% CI = 0.83–0.98, p &lt; 0.001). Volume &gt; 122 cm3 was 82% sensitive and 82% specific for SIH; volume &gt; 126 cm3 was 100% specific. Regional thoracic volume was slightly higher in patients with SIH (61.6 and 57.8 cm3, respectively, p = 0.020), and lumbar volume was notably higher (46.6 and 33.0 cm3, respectively, p &lt; 0.001). Conclusion: Patients with SIH have a significantly larger thecal sac than controls, which can be an effective tool to diagnose these patients. Plain Language Summary: This study examined whether the size and shape of the fluid‐filled space around the spinal cord, called the thecal sac, could help diagnose spontaneous intracranial hypotension (SIH), a condition with low spinal fluid volume, from leaking spinal fluid. Using spinal magnetic resonance imaging scans from 28 patients with SIH and 28 controls, we found that people with SIH had significantly larger thecal sacs than those without the condition. These volume differences could help doctors more accurately identify SIH using noninvasive MRI. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Headache: The Journal of Head &amp; Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/head.15014
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      – Code: eng
        Text: English
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        PageCount: 9
        StartPage: 1394
    Subjects:
      – SubjectFull: Diagnosis of brain diseases
        Type: general
      – SubjectFull: Cross-sectional method
        Type: general
      – SubjectFull: Statistical power analysis
        Type: general
      – SubjectFull: Body mass index
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      – SubjectFull: Receiver operating characteristic curves
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      – SubjectFull: Research funding
        Type: general
      – SubjectFull: T-test (Statistics)
        Type: general
      – SubjectFull: Data analysis
        Type: general
      – SubjectFull: Cerebrospinal fluid leak
        Type: general
      – SubjectFull: Scientific observation
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      – SubjectFull: Brain diseases
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      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Chi-squared test
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Longitudinal method
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      – SubjectFull: Connective tissue diseases
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      – SubjectFull: Lumbar vertebrae
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      – SubjectFull: Statistics
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      – SubjectFull: Comparative studies
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      – SubjectFull: Data analysis software
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Sensitivity & specificity (Statistics)
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      – TitleFull: Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension.
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            – D: 01
              M: 09
              Text: Sep2025
              Type: published
              Y: 2025
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