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Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema.
J Neuroophthalmol. 2019 09; 39(3):299-307.JN

Abstract

OBJECTIVE

Revised diagnostic criteria for idiopathic intracranial hypertension (IIH) were proposed in part to reduce misdiagnosis of intracranial hypertension without papilledema (WOP) by using 3 or 4 MRI features of intracranial hypertension when a sixth nerve palsy is absent. This study was undertaken to evaluate the sensitivity and specificity of the MRI criteria and to validate their utility for diagnosing IIH in patients with chronic headaches and elevated opening pressure (CH + EOP), but WOP.

METHODS

Brain MRIs from 80 patients with IIH with papilledema (WP), 33 patients with CH + EOP, and 70 control patients with infrequent episodic migraine were assessed in a masked fashion for MRI features of intracranial hypertension.

RESULTS

Reduced pituitary gland height was moderately sensitive for IIH WP (80%) but had low specificity (64%). Increased optic nerve sheath diameter was less sensitive (51%) and only moderately specific (83%). Flattening of the posterior globe was highly specific (97%) but had low sensitivity (57%). Transverse venous sinus stenosis was moderately sensitive for IIH WP (78%) but of undetermined specificity. A combination of any 3 of 4 MRI features was nearly 100% specific, while maintaining a sensitivity of 64%. Of patients with CH + EOP, 30% had 3 or more MRI features, suggesting IIH WOP in those patients.

CONCLUSION

A combination of any 3 of 4 MRI features is highly specific for intracranial hypertension and suggests IIH WOP when present in patients with chronic headache and no papilledema.

Authors+Show Affiliations

Department of Neurology (RMM), Brigham and Women's Hospital, Boston, Massachusetts; Department of Ophthalmology (RMM), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; East Tennessee Medical Group-Neurology (OFR), Blount Memorial Hospital, Maryville, Tennessee; Department of Radiology (JHW, YJC), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Texas Neurology Consultants (SR), Texas Health Resources, Plano, Texas; Department of Radiology (KLS, LL), University of Utah School of Medicine, Salt Lake City, Utah; Department of Radiology (MCP), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Ophthalmology (MAT, KSS, GTL), University of Pennsylvania Scheie Eye Institute, Philadelphia, Pennsylvania; Departments of Ophthalmology and Neurology (KBD), University of Utah School of Medicine, Salt Lake City, Utah; Departments of Neurology and Neurotherapeutics and Ophthalmology (DIF), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Neurology (MAT, KSS, GTL), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Ophthalmology (GTL), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30829949

Citation

Mallery, Robert M., et al. "Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema." Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, vol. 39, no. 3, 2019, pp. 299-307.
Mallery RM, Rehmani OF, Woo JH, et al. Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema. J Neuroophthalmol. 2019;39(3):299-307.
Mallery, R. M., Rehmani, O. F., Woo, J. H., Chen, Y. J., Reddi, S., Salzman, K. L., Pinho, M. C., Ledbetter, L., Tamhankar, M. A., Shindler, K. S., Digre, K. B., Friedman, D. I., & Liu, G. T. (2019). Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema. Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, 39(3), 299-307. https://doi.org/10.1097/WNO.0000000000000767
Mallery RM, et al. Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema. J Neuroophthalmol. 2019;39(3):299-307. PubMed PMID: 30829949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of Magnetic Resonance Imaging Features for Improving the Diagnosis of Idiopathic Intracranial Hypertension Without Papilledema. AU - Mallery,Robert M, AU - Rehmani,Obeidurahman F, AU - Woo,John H, AU - Chen,Yin Jie, AU - Reddi,Sudama, AU - Salzman,Karen L, AU - Pinho,Marco C, AU - Ledbetter,Luke, AU - Tamhankar,Madhura A, AU - Shindler,Kenneth S, AU - Digre,Kathleen B, AU - Friedman,Deborah I, AU - Liu,Grant T, PY - 2019/3/5/pubmed PY - 2020/6/17/medline PY - 2019/3/5/entrez SP - 299 EP - 307 JF - Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society JO - J Neuroophthalmol VL - 39 IS - 3 N2 - OBJECTIVE: Revised diagnostic criteria for idiopathic intracranial hypertension (IIH) were proposed in part to reduce misdiagnosis of intracranial hypertension without papilledema (WOP) by using 3 or 4 MRI features of intracranial hypertension when a sixth nerve palsy is absent. This study was undertaken to evaluate the sensitivity and specificity of the MRI criteria and to validate their utility for diagnosing IIH in patients with chronic headaches and elevated opening pressure (CH + EOP), but WOP. METHODS: Brain MRIs from 80 patients with IIH with papilledema (WP), 33 patients with CH + EOP, and 70 control patients with infrequent episodic migraine were assessed in a masked fashion for MRI features of intracranial hypertension. RESULTS: Reduced pituitary gland height was moderately sensitive for IIH WP (80%) but had low specificity (64%). Increased optic nerve sheath diameter was less sensitive (51%) and only moderately specific (83%). Flattening of the posterior globe was highly specific (97%) but had low sensitivity (57%). Transverse venous sinus stenosis was moderately sensitive for IIH WP (78%) but of undetermined specificity. A combination of any 3 of 4 MRI features was nearly 100% specific, while maintaining a sensitivity of 64%. Of patients with CH + EOP, 30% had 3 or more MRI features, suggesting IIH WOP in those patients. CONCLUSION: A combination of any 3 of 4 MRI features is highly specific for intracranial hypertension and suggests IIH WOP when present in patients with chronic headache and no papilledema. SN - 1536-5166 UR - https://www.unboundmedicine.com/medline/citation/30829949/Utility_of_Magnetic_Resonance_Imaging_Features_for_Improving_the_Diagnosis_of_Idiopathic_Intracranial_Hypertension_Without_Papilledema_ DB - PRIME DP - Unbound Medicine ER -