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The additive value of complementing diagnostic idiopathic intracranial hypertension criteria by MRI - an external
Stefan Macher1,2, Wolfgang Marik2,3, Nik Krajnc1,2
1Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
Background:
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).
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
New diagnostic criteria for idiopathic intracranial hypertension (IIH) simplify diagnosis. A two-out-of-three finding rule, including MRI, accurately identifies IIH patients in clinical practice.
Area of Science:
- Neurology
- Radiology
- Ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) diagnosis can be challenging.
- Recent proposals include standardized MRI criteria for IIH identification.
- A proposed definition uses two of three objective findings: papilledema, elevated cerebrospinal fluid opening pressure (CSF-OP), or specific neuroimaging signs.
Purpose of the Study:
- To validate the proposed diagnostic criteria for IIH.
- To assess the accuracy of a standardized MRI criterion for IIH diagnosis.
- To evaluate the overall accuracy of the new two-out-of-three IIH definition.
Main Methods:
- Retrospective application of proposed IIH criteria to a clinical cohort.
- Blinded expert neuroradiologist re-evaluation of neuroimaging for IIH signs.
- Calculation of diagnostic accuracy for the MRI criterion and the overall 2/3 criteria.
Main Results:
- The MRI criterion (≥3/4 signs) showed 39.2% sensitivity and 91.3% specificity.
- Positive predictive value (PPV) for MRI signs was 95.2%, negative predictive value (NPV) was 25.3%.
- The 2/3 IIH definition accurately classified all patients, including those without IIH and those with IIH without papilledema.
Conclusions:
- Standardized neuroimaging criteria are practical for routine clinical use in IIH diagnosis.
- These criteria offer moderate sensitivity and high specificity for identifying IIH.
- Defining IIH using a 2/3 rule simplifies diagnosis without loss of accuracy.
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