Abstract
BackgroundThe idiopathic intracranial hypertension is a disease that is represented by high intracranial pressure of unknown reason. The visual disturbance presents the main medical problem of this syndrome. This study was conducted to assess the diagnostic value of the optic nerve sheath diameter (ONSD) measured using MRI 3D DRIVE in the diagnosis of idiopathic intracranial hypertension.ResultsThe mean value of the ONSD measured using 3D DRIVE sequence in the patient group (5.81 ± 0.33) was significantly higher than the mean value of the normal control group (4.95 ± 0.45) (p < 0.001). The optimal optic nerve sheath diameter cut-off value for diagnosing idiopathic intracranial hypertension was > 5.31 mm, with 94.12% sensitivity and 93.3% negative predictive value.ConclusionThe high resolution of 3D DRIVE provides an accurate measurement of ONSD which correlated with elevated cerebrospinal fluid pressure and hence the diagnosis of idiopathic intracranial hypertension.
Highlights
The idiopathic intracranial hypertension is a disease that is represented by high intracranial pressure of unknown reason
Based on the area under receiver operating characteristic (ROC) curve of 0.929 (CI 95% = 0.786 to 0.989), the estimated optimal optic nerve sheath diameter (ONSD) cutoff value measured in the 3D DRIVE sequence for detecting raised intracranial pressure (ICP) more than 20 mmHg was > 5.31 mm, with sensitivity of 94.12%, specificity of 82.53%, negative predictive value of 93.3%, and 84.2% positive predictive value and overall accuracy of 88.24% (Table 3) (Fig. 1), and at this cut-off value there was only one falsenegative case in which the ONSD was 5.2 mm, yet the lumbar puncture revealed high opening cerebrospinal fluid (CSF) pressure, and three normal volunteers who were diagnosed as false-positive cases, as the ONSD was high measuring 5.61, 5.66, and 5.73 mm, yet they did not suffer from any sign or symptom of intracranial hypertension
The overall accuracy of the ONSD measured in the T2 WI was of less value measuring 76.47%, at the optimal cut-off point of ONSD > 5.6 mm, with 88.2% sensitivity, 64.71% specificity, 71.43% positive predictive value, and 84.62% negative predictive value, and at lower cut-off value of ONSD > 5.31 mm, the sensitivity was increased to reach 94.12% yet with remarkable reduction in the specificity down to 52.94% (Figs. 2 and 3)
Summary
The idiopathic intracranial hypertension is a disease that is represented by high intracranial pressure of unknown reason. This study was conducted to assess the diagnostic value of the optic nerve sheath diameter (ONSD) measured using MRI 3D DRIVE in the diagnosis of idiopathic intracranial hypertension. The idiopathic intracranial hypertension syndrome (IIH) is a disease that is characterized by high intracranial pressure with no known cause, and it predominantly affects young females [1]. The cerebrospinal fluid (CSF) accumulates in the retrobulbar optic nerve sheath due to raised CSF pressure, and the direct measurement of such CSF accumulation may provide an earlier tool for diagnosing and measurement of intracranial hypertension. Highresolution MRI can be used as a tool for measuring optic nerve sheath diameter (ONSD) adding in diagnosis of raised intracranial pressure [5, 6]. A positive correlation was found between the measurement of optic nerve sheath diameter and the intracranial pressure value, so the optic nerve sheath diameter value can be used as an additional criterion for the diagnosis of increased intracranial pressure [7]
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