Moreno-Gómez Luz Angela, Quintero-Pulgarín Daniel, Espitia Segura Oscar Mauricio, Chiquiza-Garzón Leidy Carolina, Farfán-Albarracín Juan David, Ramírez-Sierra Cristina Lorena, Zuñiga-Zambrano Yenny Carolina, Ceballos-Inga Leydi Alexandra
Department of Pediatric Radiology, HOMI Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia.
School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
Eur J Pediatr. 2025 Mar 1;184(3):218. doi: 10.1007/s00431-025-06025-8.
The diagnostic accuracy of magnetic resonance (MRI) signs of intracranial hypertension (ICH) in children remains unclear. This study aims to assess how brain MRI signs of ICH correlate with cerebrospinal fluid opening pressure (CSFOP). A retrospective case-control study was conducted with 77 children aged 1 to 18 years, who underwent brain MRI and lumbar puncture with CSFOP measurement. A blinded radiologist evaluated key ICH signs, including distension of the perioptic subarachnoid space, optic nerve (ON) tortuosity, posterior scleral flattening, intraocular protrusion, and enhancement of the prelaminar ON, among others. Odds ratios, likelihood ratios, predictive values, sensitivity, specificity, and the area under the ROC curve (AUROC), were calculated in relation to CSFOP, adjusted for age and sex. The ICH group included 38 patients (49.3%) and the control group 39 (50.7%). The presence of four or more MRI signs of ICH provided the best diagnostic performance (specificity 92%, sensitivity 40%, AUROC 0.759) for identifying elevated CSFOP, particularly with intraocular protrusion of the prelaminar ON (p = 0.006, median CSFOP 49.6 cm HO, p < .001) and papilledema (p = 0.042).
The presence of four or more MRI signs is associated with elevated CSFOP in children with non-structural ICH.
• The diagnostic accuracy of magnetic resonance imaging (MRI) signs of intracranial hypertension (ICH) in children remains unclear. • In children, there is no consensus about the most appropriate diagnostic criteria or robust evidence regarding the diagnostic performance of imaging signs for ICH.
• The presence of four or more MRI signs is associated with elevated cerebrospinal fluid opening pressure (CSFOP) in children with non-structural ICH. • Intraocular protrusion of the prelaminar ON, and papilledema are particularly relevant signs for identifying elevated CSFOP.
儿童颅内高压（ICH）的磁共振成像（MRI）征象的诊断准确性仍不明确。本研究旨在评估ICH的脑MRI征象与脑脊液开放压（CSFOP）之间的相关性。对77例年龄在1至18岁的儿童进行了一项回顾性病例对照研究，这些儿童接受了脑部MRI检查和腰椎穿刺并测量了CSFOP。一名盲法放射科医生评估了关键的ICH征象，包括视周蛛网膜下腔扩张、视神经（ON）迂曲、后巩膜扁平、眼球内突出以及视盘前ON强化等。计算了与CSFOP相关的优势比、似然比、预测值、敏感性、特异性以及ROC曲线下面积（AUROC），并对年龄和性别进行了校正。ICH组包括38例患者（49.3%），对照组39例（50.7%）。存在四种或更多的ICH的MRI征象对于识别升高的CSFOP具有最佳诊断性能（特异性92%，敏感性40%，AUROC 0.759），特别是视盘前ON的眼球内突出（p = 0.006，CSFOP中位数49.6 cm H₂O，p < 0.001）和视乳头水肿（p = 0.042）。
在非结构性ICH儿童中，存在四种或更多的MRI征象与升高的CSFOP相关。
• 儿童颅内高压（ICH）的磁共振成像（MRI）征象的诊断准确性仍不明确。• 对于儿童，关于ICH的最合适诊断标准或成像征象诊断性能的有力证据尚无共识。
• 在非结构性ICH儿童中，存在四种或更多的MRI征象与升高的脑脊液开放压（CSFOP）相关。• 视盘前ON的眼球内突出和视乳头水肿是识别升高的CSFOP的特别相关征象。
