Magnetic resonance signs of intracranial hypertension in children: a retrospective case-control study.

Abstract

The diagnostic accuracy of magnetic resonance (MRI) signs of intracranial hypertension (ICH) in children remains unclear. This study aims to assess how brain MRI signs of ICH correlate with cerebrospinal fluid opening pressure (CSFOP). A retrospective case-control study was conducted with 77 children aged 1 to 18 years, who underwent brain MRI and lumbar puncture with CSFOP measurement. A blinded radiologist evaluated key ICH signs, including distension of the perioptic subarachnoid space, optic nerve (ON) tortuosity, posterior scleral flattening, intraocular protrusion, and enhancement of the prelaminar ON, among others. Odds ratios, likelihood ratios, predictive values, sensitivity, specificity, and the area under the ROC curve (AUROC), were calculated in relation to CSFOP, adjusted for age and sex. The ICH group included 38 patients (49.3%) and the control group 39 (50.7%). The presence of four or more MRI signs of ICH provided the best diagnostic performance (specificity 92%, sensitivity 40%, AUROC 0.759) for identifying elevated CSFOP, particularly with intraocular protrusion of the prelaminar ON (p = 0.006, median CSFOP 49.6 cm H₂O, p < .001) and papilledema (p = 0.042).

Conclusion: The presence of four or more MRI signs is associated with elevated CSFOP in children with non-structural ICH.

What is known: • The diagnostic accuracy of magnetic resonance imaging (MRI) signs of intracranial hypertension (ICH) in children remains unclear. • In children, there is no consensus about the most appropriate diagnostic criteria or robust evidence regarding the diagnostic performance of imaging signs for ICH.

What is new: • The presence of four or more MRI signs is associated with elevated cerebrospinal fluid opening pressure (CSFOP) in children with non-structural ICH. • Intraocular protrusion of the prelaminar ON, and papilledema are particularly relevant signs for identifying elevated CSFOP.