Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension

Objective: To systematically review the potential value of MRI signs in the assessment of intracranial hypertension (IIH).

Methods: MEDLINE and Embase were systematically searched for original studies investigating the accuracy of MRI signs in diagnosing IIH. Methodologic quality of included studies was assessed. Sensitivity and specificity were pooled with a bivariate random-effects model.

Results: Twenty-one studies, comprising a total of 724 patients with IIH, were included. All studies had a case-control design. "Empty" sella (11 studies), posterior displacement of pituitary stalk (2 studies), meningoceles (2 studies), posterior globe flattening (8 studies), optic nerve head protrusion (6 studies), optic nerve enhancement (3 studies), optic nerve sheath distension (12 studies), optic nerve tortuosity (7 studies), slit-like ventricles (4 studies), tight subarachnoid spaces (3 studies), and inferior position of cerebellar tonsils (4 studies) had pooled sensitivity ranging between 6.1% and 68.6%, and pooled specificity ranging between 84.0% and 99.2%. Transverse sinus stenosis (8 studies) had pooled sensitivity of 84.4%; (95% CI: 65.9-93.9%) and pooled specificity of 94.9% (95% CI: 91.7-96.9%).

Conclusion: "Empty" sella, posterior pituitary stalk displacement, meningoceles, posterior globe flattening, optic nerve head protrusion, optic nerve enhancement, optic nerve sheath distension, optic nerve tortuosity, slit-like ventricles, tight subarachnoid spaces, and inferior position of cerebellar tonsils have overall high specificity but low sensitivity. Transverse sinus stenosis appears to be the most useful sign, because it has high specificity and fairly high sensitivity.