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.
J Neuroophthalmol. 2019 Sep;39(3):299-307. doi: 10.1097/WNO.0000000000000767.
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.
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.
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.
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.
特发性颅内高压（IIH）的修订诊断标准部分是为了减少在没有第六神经麻痹时使用颅内高压的 3 或 4 种 MRI 特征来诊断无视乳头水肿的颅内高压（WOP）的误诊。本研究旨在评估 MRI 标准的敏感性和特异性，并验证其在慢性头痛和颅内压升高（CH + EOP）但无 WOP 的患者中诊断 IIH 的效用。
对 80 例 IIH 伴视乳头水肿（WP）患者、33 例 CH + EOP 患者和 70 例偶发性偏头痛发作频繁的对照患者的脑 MRI 进行了盲法评估，以评估颅内高压的 MRI 特征。
垂体高度降低对 IIH WP 具有中度敏感性（80%），但特异性较低（64%）。视神经鞘直径增加的敏感性较低（51%），特异性仅为中度（83%）。后球扁平高度特异（97%），但敏感性较低（57%）。横窦狭窄对 IIH WP 的敏感性中等（78%），特异性尚未确定。4 种 MRI 特征中的任意 3 种的组合特异性接近 100%，同时保持 64%的敏感性。CH + EOP 患者中有 30%有 3 种或更多 MRI 特征，提示这些患者存在 IIH WOP。
4 种 MRI 特征中的任意 3 种的组合对颅内高压具有高度特异性，并提示存在慢性头痛且无视乳头水肿的患者存在 IIH WOP。
