The following is a summary of “Enhancing Diagnostic Accuracy through Neuroimaging Revisions in Pediatric Pseudotumor Cerebri Syndrome: A Cross-Sectional Study,” published in the February 2024 issue of Pediatrics by Masri al.
In this cross-sectional study, the researchers aimed to comprehensively document neuroimaging findings indicative of raised intracranial pressure in children diagnosed with pseudotumor cerebri syndrome (PTCS) before and after re-evaluation by two independent neuroradiologists. The study group analyzed data from 48 pediatric patients diagnosed with PTCS between 2016 and 2021, extracting clinical and radiological information from their medical records. Following independent re-evaluations by the neuroradiologists, the investigators compared their combined assessments to the initial neuroimaging reports and conducted a thorough review to assess interclass and intraclass correlation. The findings revealed initial underreporting of abnormal neuroimaging findings, with only 26 out of 48 patients (54.1%) initially identified as having abnormal reports. However, this proportion significantly increased after the revision process to 44 out of 48 patients (91.6%).
Notably, distention of the peri-optic space emerged as the most frequently reported finding post-revision, accounting for 76% of cases. Additionally, underreported findings such as flattening of the posterior globe and empty sella showed improvement upon revision. Moreover, the study identified several neuroimaging findings suggesting increased intracranial pressure, even in cases not meeting Friedman’s criteria, including narrowing the Meckel’s cave, posterior displacement of the pituitary stalk, and cavernous sinus. While their analysis of associations between neuroimaging findings and demographic/clinical characteristics yielded no statistically significant results, interclass and intraclass correlation analyses demonstrated substantial agreement between raters and within each rater’s assessment (P<0.05).
In conclusion, the study underscores the critical role of image revision in refining PTCS diagnosis. The robust intra and interclass correlations affirm the reliability of the review process, emphasizing the necessity of meticulous image analysis in clinical practice.
Source: sciencedirect.com/science/article/abs/pii/S0887899424000535