Photo Credit: Jacob Wackerhausen

The following is a summary of “Additive value of complementing diagnostic idiopathic intracranial hypertension criteria by MRI – an external validation study,” published in the May 2024 issue of Pain by Macher et al.

Researchers conducted a retrospective study to assess the validity of a new diagnostic approach for idiopathic intracranial hypertension (IIH) that combines papilledema, cerebrospinal fluid pressure, and specific MRI findings.

They applied the suggested diagnostic criteria from the Vienna IIH database to their cohort of patients with clinical suspicion of IIH. Neuroimaging underwent reevaluation for IIH signs based on standardized definitions by a blinded expert neuroradiologist. The isolated diagnostic accuracy of the neuroimaging criterion (≥ 3/4 signs) and the overall accuracy of the new proposed criteria were determined.

The results showed that patients with IIH (n = 102) and patients without IIH (no-IIH, n = 23) were included. Baseline characteristics were balanced between IIH and no-IIH groups, but papilledema and CSF-OP were significantly higher in IIH. Regarding the presence of ≥ 3/4 MRI signs, sensitivity stood at 39.2%, specificity at 91.3%, with a positive predictive value (PPV) of 95.2% and negative predictive value (NPV) of 25.3%. Reclassifying the cohort according to the 2/3 IIH definition correctly identified 100% of patients without IIH with definite IIH and suggested having IIH without papilledema according to Friedman criteria, respectively.

Investigators concluded that incorporating standardized MRI criteria into the IIH diagnosis simplified the process while maintaining accuracy, offering moderate sensitivity and excellent specificity for identifying patients with IIH.

Source: thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01781-8