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Papilloedema: diffusion-weighted imaging of optic nerve head

N Ray1, S Vyas1, N Khandelwal1

  • 1Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Clinical Radiology
|June 17, 2019
PubMed
Abstract

Insights

Diffusion-weighted imaging (DWI) reveals significant correlation between optic nerve head (ONH) diffusion abnormalities and papilledema clinical grades. These findings suggest DWI parameters can serve as a surrogate marker for intracranial pressure.

Area of Science:

  • Neuroradiology
  • Ophthalmology
  • Neurology

Background:

  • Papilledema, characterized by optic nerve head (ONH) swelling, is a clinical sign of elevated intracranial pressure.
  • Accurate assessment of papilledema severity is crucial for timely intervention and management.
  • Diffusion-weighted imaging (DWI) offers a non-invasive method to evaluate tissue microstructural changes.

Purpose of the Study:

  • To investigate the correlation between the clinical grading of papilledema and diffusion abnormalities in the ONH using DWI.
  • To determine if DWI-derived parameters can serve as objective markers for papilledema severity and intracranial pressure.

Main Methods:

  • Brain MRI with DWI was performed on 32 patients with papilledema and 32 controls.
  • Clinical grading of papilledema utilized the modified Frisen scale.
  • ONH hyperintensity and apparent diffusion coefficient (ADC) values were analyzed, with statistical comparisons using Chi-square, Fisher's exact, ANOVA, and Student's t-tests. ROC analysis determined cut-off ADC values.

Main Results:

  • A significant correlation was observed between ONH hyperintensity and ADC values with clinical papilledema grades.
  • ONH hyperintensity demonstrated high sensitivity (87.5%) and specificity (>97%) for detecting papilledema.
  • A mean cut-off ONH ADC value showed high sensitivity (96.83%) and specificity (95.31%) in differentiating cases from controls.

Conclusions:

  • Diffusion parameters of the ONH are significantly correlated with the clinical grading of papilledema.
  • DWI-derived ONH diffusion parameters show potential as non-invasive surrogate markers for elevated intracranial pressure.
  • These findings support the utility of DWI in the objective assessment of papilledema.

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