Comparison of ocular ultrasonography and magnetic resonance imaging for detection of increased intracranial pressure

David F. Patterson, Mai Lan Ho, Jacqueline A. Leavitt, Nathan Smischney, Sara E. Hocker, Eelco F. Wijdicks, David O. Hodge, John Chen

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background/aims: To evaluate and compare the performance of ocular ultrasonography (US) and magnetic resonance imaging (MRI) for detecting increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Methods: Twenty-two patients with papilledema from IIH and 22 with pseudopapilledema were prospectively recruited based on funduscopic and clinical findings. Measurements of optic nerve sheath diameters (ONSDs) 3 mm behind the inner sclera were performed on B-scan US and axial T2-weighted MRI examinations. Pituitary-to-sella height ratio (pit/sella) was also calculated from sagittal T1-weighted MRI images. Lumbar puncture was performed in all patients with IIH and in five patients with pseudopapilledema. Results: Average US and MRI ONSD were 4.4 (SD ± 0.7) and 5.2 ± 1.4 mm for the pseudopapilledema group and 5.2 ± 0.6 and 7.2 ± 1.6 mm for the papilledema group (p < 0.001). Average MRI pit/sella ratio was 0.7 ± 0.3 for the pseudopapilledema group and 0.3 ± 0.2 for the papilledema group (p < 0.001). Based on receiver-operator curve analysis, the optimal thresholds for detecting papilledema are US ONSD > 4.8 mm, MRI ONSD > 6.0 mm, and MRI pit/sella < 0.5. Combining a dilated US ONSD or MRI ONSD with a below-threshold MRI pit/sella ratio yielded a sensitivity of 73% and specificity of 96% for detecting IIH. Adding the US ONSD to the MRI ONSD and pit/sella ratio only increased the sensitivity by 5% and did not change specificity. Conclusion: US and MRI provide measurements of ONSD that are well-correlated and sensitive markers for increased ICP. The combination of the ONSD and the pit/sella ratio can increase specificity for the diagnosis of IIH.

Original languageEnglish (US)
Article number278
JournalFrontiers in Neurology
Volume9
Issue numberAPR
DOIs
StatePublished - Apr 24 2018

Keywords

  • Empty sella
  • Idiopathic intracranial hypertension
  • Magnetic resonance imaging
  • Optic nerve sheath
  • Pseudotumor cerebri
  • Ultrasonography

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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