Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure
Background/aimsTo evaluate and compare the performance of ocular ultrasonography (US) and magnetic resonance imaging (MRI) for detecting increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH).MethodsTwenty-two patients with papilledema from IIH and 22 with...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fneur.2018.00278/full |
| _version_ | 1818901638511853568 |
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| author | David F. Patterson Mai-Lan Ho Jacqueline A. Leavitt Nathan J. Smischney Sara E. Hocker Eelco F. Wijdicks David O. Hodge John Jing-Wei Chen John Jing-Wei Chen |
| author_facet | David F. Patterson Mai-Lan Ho Jacqueline A. Leavitt Nathan J. Smischney Sara E. Hocker Eelco F. Wijdicks David O. Hodge John Jing-Wei Chen John Jing-Wei Chen |
| author_sort | David F. Patterson |
| collection | DOAJ |
| description | Background/aimsTo evaluate and compare the performance of ocular ultrasonography (US) and magnetic resonance imaging (MRI) for detecting increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH).MethodsTwenty-two patients with papilledema from IIH and 22 with pseudopapilledema were prospectively recruited based on funduscopic and clinical findings. Measurements of optic nerve sheath diameters (ONSDs) 3 mm behind the inner sclera were performed on B-scan US and axial T2-weighted MRI examinations. Pituitary-to-sella height ratio (pit/sella) was also calculated from sagittal T1-weighted MRI images. Lumbar puncture was performed in all patients with IIH and in five patients with pseudopapilledema.ResultsAverage US and MRI ONSD were 4.4 (SD ± 0.7) and 5.2 ± 1.4 mm for the pseudopapilledema group and 5.2 ± 0.6 and 7.2 ± 1.6 mm for the papilledema group (p < 0.001). Average MRI pit/sella ratio was 0.7 ± 0.3 for the pseudopapilledema group and 0.3 ± 0.2 for the papilledema group (p < 0.001). Based on receiver-operator curve analysis, the optimal thresholds for detecting papilledema are US ONSD > 4.8 mm, MRI ONSD > 6.0 mm, and MRI pit/sella < 0.5. Combining a dilated US ONSD or MRI ONSD with a below-threshold MRI pit/sella ratio yielded a sensitivity of 73% and specificity of 96% for detecting IIH. Adding the US ONSD to the MRI ONSD and pit/sella ratio only increased the sensitivity by 5% and did not change specificity.ConclusionUS and MRI provide measurements of ONSD that are well-correlated and sensitive markers for increased ICP. The combination of the ONSD and the pit/sella ratio can increase specificity for the diagnosis of IIH. |
| first_indexed | 2024-12-19T20:22:56Z |
| format | Article |
| id | doaj.art-82c79786cc8f477bb9af31b73911061c |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-19T20:22:56Z |
| publishDate | 2018-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-82c79786cc8f477bb9af31b73911061c2022-12-21T20:06:56ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-04-01910.3389/fneur.2018.00278355999Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial PressureDavid F. Patterson0Mai-Lan Ho1Jacqueline A. Leavitt2Nathan J. Smischney3Sara E. Hocker4Eelco F. Wijdicks5David O. Hodge6John Jing-Wei Chen7John Jing-Wei Chen8Department of Ophthalmology, Mayo Clinic, Rochester, NY, United StatesDepartment of Radiology, Mayo Clinic, Rochester, NY, United StatesDepartment of Ophthalmology, Mayo Clinic, Rochester, NY, United StatesDepartment of Anesthesiology, Mayo Clinic, Rochester, NY, United StatesDepartment Neurology, Mayo Clinic, Rochester, NY, United StatesDepartment Neurology, Mayo Clinic, Rochester, NY, United StatesDepartment Health Sciences Research, Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United StatesDepartment of Ophthalmology, Mayo Clinic, Rochester, NY, United StatesDepartment Neurology, Mayo Clinic, Rochester, NY, United StatesBackground/aimsTo evaluate and compare the performance of ocular ultrasonography (US) and magnetic resonance imaging (MRI) for detecting increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH).MethodsTwenty-two patients with papilledema from IIH and 22 with pseudopapilledema were prospectively recruited based on funduscopic and clinical findings. Measurements of optic nerve sheath diameters (ONSDs) 3 mm behind the inner sclera were performed on B-scan US and axial T2-weighted MRI examinations. Pituitary-to-sella height ratio (pit/sella) was also calculated from sagittal T1-weighted MRI images. Lumbar puncture was performed in all patients with IIH and in five patients with pseudopapilledema.ResultsAverage US and MRI ONSD were 4.4 (SD ± 0.7) and 5.2 ± 1.4 mm for the pseudopapilledema group and 5.2 ± 0.6 and 7.2 ± 1.6 mm for the papilledema group (p < 0.001). Average MRI pit/sella ratio was 0.7 ± 0.3 for the pseudopapilledema group and 0.3 ± 0.2 for the papilledema group (p < 0.001). Based on receiver-operator curve analysis, the optimal thresholds for detecting papilledema are US ONSD > 4.8 mm, MRI ONSD > 6.0 mm, and MRI pit/sella < 0.5. Combining a dilated US ONSD or MRI ONSD with a below-threshold MRI pit/sella ratio yielded a sensitivity of 73% and specificity of 96% for detecting IIH. Adding the US ONSD to the MRI ONSD and pit/sella ratio only increased the sensitivity by 5% and did not change specificity.ConclusionUS and MRI provide measurements of ONSD that are well-correlated and sensitive markers for increased ICP. The combination of the ONSD and the pit/sella ratio can increase specificity for the diagnosis of IIH.http://journal.frontiersin.org/article/10.3389/fneur.2018.00278/fulloptic nerve sheathultrasonographyidiopathic intracranial hypertensionmagnetic resonance imagingempty sellapseudotumor cerebri |
| spellingShingle | David F. Patterson Mai-Lan Ho Jacqueline A. Leavitt Nathan J. Smischney Sara E. Hocker Eelco F. Wijdicks David O. Hodge John Jing-Wei Chen John Jing-Wei Chen Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure Frontiers in Neurology optic nerve sheath ultrasonography idiopathic intracranial hypertension magnetic resonance imaging empty sella pseudotumor cerebri |
| title | Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure |
| title_full | Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure |
| title_fullStr | Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure |
| title_full_unstemmed | Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure |
| title_short | Comparison of Ocular Ultrasonography and Magnetic Resonance Imaging for Detection of Increased Intracranial Pressure |
| title_sort | comparison of ocular ultrasonography and magnetic resonance imaging for detection of increased intracranial pressure |
| topic | optic nerve sheath ultrasonography idiopathic intracranial hypertension magnetic resonance imaging empty sella pseudotumor cerebri |
| url | http://journal.frontiersin.org/article/10.3389/fneur.2018.00278/full |
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