Comparison of Suprasellar Cistern Height Measurements Between Coronal and Sagittal Planes

The Bern score was developed for cerebral spinal fluid leak determination and spontaneous intracranial hypotension (SIH) diagnosis. Suprasellar cistern height (SCH) is an important imaging sign in Bern score. However, the way to measure SCH is vague, and results from different studies vary.

This case-control study included SIH patients presented to our institution. Blind reviews were conducted by 2 readers for magnetic resonance images of SIH patients and control participants. SCHs on coronal and sagittal sections were measured. Intermethod agreement was evaluated with intraclass correlation coefficient, and logistic regression was performed to assess the association between various SCHs and SIH.

Thirty-nine SIH patients and 39 control participants were investigated. SCH demonstrated excellent intermethod agreement between measurements in the coronal and sagittal planes (intraclass correlation coefficient: 0.971). Evaluation at the anterior margin of optic chiasm (OC) on sagittal section of all patients obtained almost the same SCH as that of patients who had coronal section intersected at the anterior portion of OC (SIH group: 3.22 ± 1.81 vs. 3.17 ± 1.67, P = 0.913; control group: 6.02 ± 2.42 vs. 5.93 ± 1.61, P = 0.888). The two SCHs measured on the sagittal section, the anterior margin of the OC and the middle of the sella turcica, had the same area under the curve (0.823 vs. 0.794, P = 0.184) and association with SIH (odds ratio = 8.41, 95% confidence interval: 2.81-25.14 vs. odds ratio = 9.17, 95% confidence interval: 3.08-27.35).

SCH measured on the sagittal section could be a reasonable substitute for that measured on the coronal section and sagittal SCH measured at the anterior margin of OC was close to the results of the original Bern score study.