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How can MRI descriptors be optimally combined to predict idiopathic intracranial hypertension?
George G Bitar1, Philip Touska2, Ata Siddiqui2,3
1Department of Radiology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom.
Objectives:
To establish how MRI descriptors on standard MRI sequences can be optimally combined to predict idiopathic intracranial hypertension (IIH).
Methods:
A retrospective single-institution cross-sectional study evaluated consecutive IIH patients undergoing MRI between 2002 and 2015 and a control group. Six established and 8 exploratory MRI descriptors were evaluated. Two observers independently analysed MRI descriptors on T1w sagittal and T2w axial sequences while blinded to clinical data with consensus obtained. Inter-rater reliability was calculated, and the presence of MRI descriptors was compared between IIH patients and controls (Bonferroni correction, P < 0.004). Forward stepwise logistic regression determined which combination of MRI descriptors best predicted IIH.
Results:
Fifty-four IIH patients (mean age 31.2, standard deviation 10.2, 3 men) and 54 control subjects (mean age 31.7, standard deviation 7.1, 3 men) were evaluated. There was excellent inter-rater reliability for 13/14 MRI descriptors. There were 4/6 established and 6/8 exploratory MRI descriptors associated with IIH (P < 0.004). The optimal combination of descriptors to predict IIH was vertical tortuosity of the optic nerve, enlarged optic nerve sheath, globe flattening score ≥ 2, Yuh score ≥ 3, cervical skin folding, and cervical fat thickness ≥ 10.5 mm. The model correctly classified 93.5% of cases (sensitivity 94.4%, specificity 92.6%, area under the receiver operating characteristic curve [AUC] 0.965).
Conclusions:
Evaluating a combination of vertical tortuosity of the optic nerve, enlarged optic nerve sheath, globe flattening, Yuh score, cervical skin folding, and cervical fat thickness optimally predicts IIH.
Advances In Knowledge:
New MRI features are validated for the diagnosis of IIH and the optimal combination for diagnosis is established.
Registration Number:
N006 (local institutional review). The full study protocol can be requested from the corresponding author.
Insights
Idiopathic intracranial hypertension (IIH) can be accurately predicted using a combination of specific MRI findings. This study identified key imaging features for optimal IIH diagnosis.
Area of Science:
- Radiology
- Neurology
- Ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by increased intracranial pressure without a clear cause.
- Accurate diagnosis of IIH is crucial for timely management and prevention of vision loss.
- Standard MRI sequences can reveal subtle signs of IIH, but an optimal combination of descriptors is needed for reliable prediction.
Purpose of the Study:
- To determine the optimal combination of magnetic resonance imaging (MRI) descriptors for predicting idiopathic intracranial hypertension (IIH).
- To validate new MRI features for IIH diagnosis.
- To establish a reliable diagnostic model for IIH using standard MRI sequences.
Main Methods:
- A retrospective cross-sectional study included 54 IIH patients and 54 controls who underwent MRI.
- Two independent observers analyzed 14 MRI descriptors (6 established, 8 exploratory) on T1w sagittal and T2w axial sequences.
- Forward stepwise logistic regression was used to identify the combination of descriptors that best predicted IIH.
Main Results:
- Excellent inter-rater reliability was achieved for most MRI descriptors.
- Four established and six exploratory MRI descriptors were significantly associated with IIH (p < 0.004).
- An optimal model combining vertical optic nerve tortuosity, enlarged optic nerve sheath, globe flattening (≥2), Yuh Score (≥3), cervical skin folding, and cervical fat thickness (≥10.5 mm) achieved 93.5% accuracy (AUC 0.965).
Conclusions:
- A combination of specific MRI features, including optic nerve sheath changes, globe flattening, Yuh Score, and cervical fat/skin findings, optimally predicts IIH.
- New MRI features have been validated, establishing an optimal diagnostic combination for IIH.
- This approach enhances the diagnostic accuracy of MRI for IIH.
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