Geniculate ganglion diverticulum: a potential imaging marker in patients with idiopathic intracranial hypertension

IF 1.8 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical Imaging Pub Date : 2024-09-11 DOI:10.1016/j.clinimag.2024.110278

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引用次数: 0

Abstract

Purpose

The diagnosis of idiopathic intracranial hypertension (IIH) is often challenging in patients who do not present with classic symptoms. Brain MRI can play a pivotal role, as several imaging findings, such as an empty sella appearance (ESA), have been shown to be associated with IIH. Yet, none of the MRI signs have been shown to have a high sensitivity and specificity. In this study, we tested the hypothesis that presence of a geniculate ganglion diverticulum (GGD) is a potential imaging marker for the detection of IIH.

Materials and methods

This is an IRB-approved, single-institution, retrospective, observational study. Brain MRI examinations of patients referred to Radiology by Otology clinic over a period of 10 years were reviewed. 244 MRI exams fulfilling inclusion and exclusion criteria were independently screened for the presence of GGD and ESA by two Neuroradiology fellows. Electronic medical records (EMR) of patients in this study were reviewed for presence of clinical manifestations of IIH. Receiver operator characteristic (ROC) curves were generated to estimate the accuracy of each covariate in diagnosing IIH. The area under each ROC curve (AUC) was calculated to identify an accurate prognostic covariate. Statistical analysis was done using R programming language V 4.2.2.

Results

GGD was identified in MRI exams of 51 patients. A 2:1 propensity score (PS) matching for age, gender, and Body Mass Index (BMI) was used to select non-GGD control group for comparison with the GGD group. There was strong agreement between the 2 reviewers (kappa = 0.81, agreement = 95 %). Twelve patients in this study were diagnosed with IIH. There was a high incidence of GGD (OR = 12.19, 95 % CI (2.56, 58.10)) and ESA (OR = 4.97, 95 % CI (1.47, 16.74)) in IIH patients. The AUC observed in GGD for predicting IIH was 0.771 (0.655–0.888), specificity = 0.709 (0.638–0.780), and sensitivity = 0.833 (0.583–1). The AUC observed for ESA in predicting IIH was 0.682 (0.532–0.831), specificity = 0.780 (0.709–0.844), and sensitivity = 0.583 (0.333–0.833).

Conclusion

GGD is potentially a novel imaging marker of IIH with sensitivity higher than and specificity comparable to that of ESA.

Clinical relevance statement

Presence of GGD should raise the possibility of IIH.

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膝状神经节憩室：特发性颅内高压患者的潜在影像学标志物

目的对于没有典型症状的患者，特发性颅内高压（IIH）的诊断往往具有挑战性。脑磁共振成像可发挥关键作用，因为一些成像结果，如空蝶鞍外观（ESA），已被证明与特发性颅内高压有关。然而，没有任何一种核磁共振成像征象被证明具有较高的敏感性和特异性。在本研究中，我们测试了这样一个假设：膝状神经节憩室（GGD）的存在是检测 IIH 的潜在影像学标志物。研究人员回顾了耳科门诊转诊至放射科的患者在 10 年间接受的脑部 MRI 检查。符合纳入和排除标准的 244 例磁共振成像检查均由两名神经放射学研究员独立筛选，以确定是否存在 GGD 和 ESA。研究还审查了患者的电子病历（EMR），以确定是否存在 IIH 的临床表现。研究人员绘制了受体运算特征曲线（ROC），以估算每个协变量在诊断 IIH 时的准确性。计算每条ROC曲线下的面积（AUC），以确定准确的预后协变量。统计分析使用 R 编程语言 V 4.2.2 进行。采用年龄、性别和体重指数（BMI）2:1倾向得分（PS）匹配法选择非GGD对照组与GGD组进行比较。两位审稿人的意见非常一致（kappa = 0.81，一致度 = 95%）。本研究中有 12 名患者被诊断为 IIH。在 IIH 患者中，GGD（OR = 12.19，95 % CI (2.56，58.10)）和 ESA（OR = 4.97，95 % CI (1.47，16.74)）的发病率很高。GGD 预测 IIH 的 AUC 为 0.771 (0.655-0.888)，特异性 = 0.709 (0.638-0.780)，灵敏度 = 0.833 (0.583-1)。在预测 IIH 方面，ESA 的 AUC 为 0.682 (0.532-0.831)，特异性 = 0.780 (0.709-0.844)，灵敏度 = 0.583 (0.333-0.833)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Imaging 医学-核医学

CiteScore

4.60

自引率

0.00%

发文量

265

审稿时长

35 days

期刊介绍： The mission of Clinical Imaging is to publish, in a timely manner, the very best radiology research from the United States and around the world with special attention to the impact of medical imaging on patient care. The journal''s publications cover all imaging modalities, radiology issues related to patients, policy and practice improvements, and clinically-oriented imaging physics and informatics. The journal is a valuable resource for practicing radiologists, radiologists-in-training and other clinicians with an interest in imaging. Papers are carefully peer-reviewed and selected by our experienced subject editors who are leading experts spanning the range of imaging sub-specialties, which include: -Body Imaging- Breast Imaging- Cardiothoracic Imaging- Imaging Physics and Informatics- Molecular Imaging and Nuclear Medicine- Musculoskeletal and Emergency Imaging- Neuroradiology- Practice, Policy & Education- Pediatric Imaging- Vascular and Interventional Radiology