Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension

Maralani, Pejman; Hassanlou, M.; Torres, Carlos; Chakraborty, Santanu; Kingstone, Michael; Patel, Virenda I.; Zackon, David H.; Bussiére, Miguel

doi:10.1016/j.crad.2011.12.002

Cited by 122 publications

(106 citation statements)

References 31 publications

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“…A transverse sinus stenosis has been found with high prevalence in patients with IIH [26,34]. Maralani found a high specificity and sensitivity of 100 and 62.8 % for a transverse sinus stenosis for IIH [14]. There is some debate about whether the transverse sinus stenosis is a cause or consequence of raised intracranial pressure.…”

Section: Discussionmentioning

confidence: 94%

“…An accurate analysis identifying the various cranial MRI features produced by elevated intracranial pressure can help diagnose IIH [23,14]. In our PT cohort, an empty sella was identified in 26 (26/33) patients on T1-weighted images.…”

Section: Discussionmentioning

confidence: 96%

“…An empty sella is an important imaging sign associated with IIH [27,13,24,23], although it is also an incidental finding in normal subjects. According to Maralani [14], empty sella had 95.3 % specificity and 65.1 % sensitivity for IIH. In a pediatric cohort [23], an empty sella had a similar specificity of 95 % and sensitivity of 26 %.…”

Section: Discussionmentioning

confidence: 98%

“…The potential association between SSDD with PT and IIH lacks clinical evidence and needs further investigation. Several imaging features suggest the presence of IIH, including an empty sella [12][13][14], increased diameter of the optic nerve sheath (ONS) [15,16], flattened posterior sclera [15,17], vertical tortuosity of the optic nerve [15,18,14], transverse sinus stenosis [19,20], and decreased ventricle size [21]. These findings suggest that the association between SSDD with PT and IIH can be preliminarily evaluated by imaging.…”

Section: Introductionmentioning

confidence: 92%

“…Each image was evaluated for the following neuroimaging features, previously reported as imaging signs of IIH (Fig. 2): (1) flattening of the posterior sclera and the posterior aspect of the optic globe relative to the normal curvature of the globe, as observed on the axial T1-weighted images [23,17]; (2) vertical tortuosity of the orbital optic nerve, indicated by a redundant and S-shaped appearance on sagittal views [14,18]; (3) protrusion of the optic nerve head, straightening of the normally outwardly convex sclera, or concavity of the sclera towards the globe at the optic nerve attachment [14,24,17]; (4) empty sella, indicated by the pituitary gland filling less than 50 % of the sellar volume [23]; and (5) transverse sinus stenosis, the smallest diameter of transverse sinus was less than 50 % of the largest diameter. Morphometric analysis for IIHassociated features was performed [13,15,25,23,14,26,27], including the pituitary gland height, pituitary grade, ONS diameter, maximum width of the third ventricle, maximum width of the fourth ventricle, and lateral ventricle size (maximum and minimum widths of the anterior horns; Fig.…”

Section: Image Interpretationmentioning

confidence: 99%

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Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

et al. 2015

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 92%

Section: Image Interpretationmentioning

confidence: 99%

See 3 more Smart Citations

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

et al. 2015

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Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

et al. 2021

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IMPORTANCE Magnetic resonance imaging (MRI) signs of intracranial hypertension (IH) are traditionally associated with idiopathic intracranial hypertension (IIH), but these signs are also detected among individuals with primary headaches and among asymptomatic individuals without papilledema.OBJECTIVE To examine the prevalence of MRI signs of IH among consecutive outpatients undergoing brain MRI for any clinical indication and to explore their association with papilledema. DESIGN, SETTING, AND PARTICIPANTSThis prospective cross-sectional study of outpatients undergoing brain MRI at 1 outpatient imaging facility was conducted between August 1, 2019, and March 31, 2020, with ocular fundus photographs taken concurrently. Radiographic images from consecutive adult patients who were undergoing brain MRI and able to participate in fundus photography were analyzed for MRI signs of IH. A univariate analysis using either Fisher exact tests or t tests was performed. MAIN OUTCOMES AND MEASURESPrevalence of MRI signs of IH and prevalence of papilledema detected on ocular fundus photographs. Radiographic signs of IH included empty sella, optic nerve head protrusion, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, enlarged Meckel caves, cephaloceles, cerebellar tonsillar descent, and bilateral transverse venous sinus stenosis.RESULTS A total of 388 patients were screened for eligibility; of those, 92 patients were excluded (58 declined participation, 16 were unable to consent, 14 were unable to complete fundus photography, and 4 completed MRI and fundus photography twice, so their second set of findings was removed). Among the 296 patients included in the study, the median age was 49.5 years (interquartile range, 37.8-62.0 years), and 188 patients (63.5%) were female. The most common indication for MRI was surveillance of a brain neoplasm (82 patients [27.7%]). Investigations of headaches (26 patients [8.8%]) and disorders of intracranial pressure (4 patients [1.4%]) were uncommon. At least 1 radiographic sign of IH was present in 145 patients (49.0%). Among 296 total study patients, 98 patients (33.1%) had empty sella, 47 patients (15.9%) had enlarged Meckel caves, 32 patients (10.8%) had increased perioptic cerebrospinal fluid, 23 patients (7.8%) had optic nerve tortuosity, 2 patients (0.7%) had scleral flattening, and 4 patients (1.4%) had cephaloceles. Bilateral transverse venous sinus stenosis was present in 6 of 198 patients (3.0%). Five patients (1.7%) had papilledema. Compared with patients without papilledema, those with papilledema had a significantly higher body mass index and history of IIH, in addition to an increased prevalence of empty sella, optic nerve tortuosity, and transverse venous sinus stenosis detected on MRI. The prevalence of papilledema increased from 2.8% among patients with at least 1 MRI sign of IH to 40.0% among patients with 4 or more MRI signs of IH.CONCLUSIONS AND RELEVANCE Magnetic resonance imaging signs of IH were common among patients undergoin...

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

139

270

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension

Cited by 122 publications

References 31 publications

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

ICAR: endoscopic skull‐base surgery

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