Microstructural White Matter Alterations in Pediatric Idiopathic Intracranial Hypertension: A Diffusion Tensor Imaging Study

Bilge Özgör ¹, Hüseyin Ayvaz ², Mahir Tan ¹

⁰Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, İnönü University, Malatya 44050, Türkiye.

Children (basel, Switzerland) +

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December 30, 2025

View abstract on PubMed

Summary

Diffusion tensor imaging (DTI) reveals white matter microstructural changes in pediatric idiopathic intracranial hypertension (IIH). Fractional anisotropy (FA) in the optic radiation shows strong diagnostic potential, complementing conventional MRI for diagnosing IIH in children.

Area Of Science

Neurology
Radiology
Pediatrics

Background

Idiopathic intracranial hypertension (IIH) is a rare but significant cause of elevated intracranial pressure in children.
Conventional MRI findings for IIH lack consistent sensitivity and specificity.
Diffusion tensor imaging (DTI) offers potential for assessing white matter microstructure in pediatric IIH.

Purpose Of The Study

To investigate the role of DTI metrics in pediatric IIH.
To compare DTI findings with conventional MRI markers of increased intracranial pressure.
To evaluate the diagnostic performance of DTI in differentiating pediatric IIH from controls.

Main Methods

Retrospective case-control study of 26 pediatric IIH patients and 26 controls.
Brain MRI with DTI was performed, measuring fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in white matter tracts.
Conventional MRI findings and DTI metrics were analyzed for associations.

Main Results

Children with IIH showed reduced FA and increased MD/RD in key white matter regions (optic radiation, corpus callosum, internal capsule).
FA correlated negatively with perioptic subarachnoid space (SAS) width; RD/MD correlated positively with posterior globe flattening and empty sella grade.
FA in the optic radiation was the strongest discriminator (AUC = 0.83) with excellent inter-observer reliability (ICC = 0.91).

Conclusions

Pediatric IIH is associated with white matter microstructural alterations detectable by DTI.
FA is a promising DTI metric for diagnosing pediatric IIH, potentially serving as an adjunct to conventional MRI.
Further validation in larger prospective studies is needed to confirm clinical utility.

Keywords:

diffusion tensor imaging fractional anisotropy idiopathic intracranial hypertension pediatric MRI white matter