Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
J Headache Pain. 2024 May 6;25(1):70. doi: 10.1186/s10194-024-01781-8.
Recently, diagnostic criteria including a standardized MRI criterion were presented to identify patients suffering from idiopathic intracranial hypertension (IIH) proposing that IIH might be defined by two out of three objective findings (papilledema, ≥ 25 cm cerebrospinal fluid opening pressure (CSF-OP) and ≥ 3/4 neuroimaging signs).
To provide independent external validation, we retrospectively applied the proposed diagnostic criteria to our cohort of patients with clinical suspicion of IIH from the Vienna IIH database. Neuroimaging was reevaluated for IIH signs according to standardized definitions by a blinded expert neuroradiologist. We determined isolated diagnostic accuracy of the neuroimaging criterion (≥ 3/4 signs) as well as overall accuracy of the new proposed criteria.
We included patients with IIH (n = 102) and patients without IIH (no-IIH, n = 23). Baseline characteristics were balanced between IIH and no-IIH groups, but papilledema and CSF-OP were significantly higher in IIH. For the presence of ≥ 3/4 MRI signs, sensitivity was 39.2% and specificity was 91.3% with positive predictive value (PPV) of 95.2% and negative predictive value (NPV) 25.3%. Reclassifying our cohort according to the 2/3 IIH definition correctly identified 100% of patients without IIH, with definite IIH and suggested to have IIH without papilledema by Friedman criteria, respectively.
The standardized neuroimaging criteria are easily applicable in clinical routine and provide moderate sensitivity and excellent specificity to identify patients with IIH. Defining IIH by 2/3 criteria significantly simplifies diagnosis without compromising accuracy.
最近，提出了包括标准化 MRI 标准在内的诊断标准，以识别患有特发性颅内高压（IIH）的患者，认为 IIH 可能由三个客观发现中的两个来定义（视乳头水肿、≥25cm 脑脊液开放压（CSF-OP）和≥3/4 神经影像学征象）。
为了提供独立的外部验证，我们回顾性地将提出的诊断标准应用于维也纳 IIH 数据库中具有 IIH 临床怀疑的患者队列。根据一位盲法神经放射学专家的标准化定义，重新评估神经影像学的 IIH 征象。我们确定了神经影像学标准（≥3/4 征象）的孤立诊断准确性以及新提出标准的整体准确性。
我们纳入了 IIH 患者（n=102）和无 IIH 患者（非 IIH，n=23）。IIH 和非 IIH 组之间的基线特征是平衡的，但 IIH 患者的视乳头水肿和 CSF-OP 明显更高。对于≥3/4 MRI 征象的存在，敏感性为 39.2%，特异性为 91.3%，阳性预测值（PPV）为 95.2%，阴性预测值（NPV）为 25.3%。根据 2/3 IIH 定义重新分类我们的队列，正确识别了 100%的非 IIH 患者、明确的 IIH 患者和根据 Friedman 标准建议无视乳头水肿的 IIH 患者。
标准化的神经影像学标准易于在临床常规中应用，具有中等的敏感性和极好的特异性，可用于识别 IIH 患者。通过 2/3 标准定义 IIH 可显著简化诊断，而不影响准确性。
