Matilde Sassani, James L Mitchell, Andreas Yiangou, Nigel Davies, Vijay Sawlani, Susan P Mollan, Mark E Wagshul, Alexandra J Sinclair
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All participants underwent lumbar puncture, visual assessments, detailed headache phenotyping, and MRI-ICP scans to calculate intracranial compliance index at baseline. Following treatment, patients were invited to attend a one-year visit when all assessments were repeated.</p><p><strong>Results: </strong>There was significant (p = 0.017) reduction in intracranial compliance index in IIH (mean = 1006.0 cc/mmHg/cm, SD = ± 384.6 cc/mmHg/cm) compared to controls (mean = 1493.0 cc/mmHg/cm, SD = ± 411.8 cc/mmHg/cm), inversely correlating with lumbar puncture opening pressure (r = -0.502, p = 0.029). A significant inverse correlation between compliance index and headache disability was also found (r = -0.458, p = 0.049) and a trend for an association between lower compliance index and increased frequency of headaches (r = -0.430, p = 0.066). This latter became significant (p = 0.018) after accounting for use of analgesics. Following successful treatment, compliance index was increased in all patients at one year (mean of differences = 380.7 cc/mmHg/cm, p = 0.031).</p><p><strong>Conclusions: </strong>This is the first study to apply the MRI-ICP technique longitudinally in IIH. 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引用次数: 0
摘要
背景/目的：特发性颅内高压（IIH）是一种威胁视力并导致致残性头痛的疾病，主要影响育龄肥胖妇女。它的特征是颅内压升高（ICP），可以通过腰椎穿刺或颅内插入监视器进行侵入性测量。发展非侵入性方法来评估颅内压的临床需求尚未得到满足。本研究旨在利用MRI-ICP成像技术测量颅内顺应性指数，并评估其作为ICP替代生物标志物的适用性。对象/方法：招募9名IIH患者和10名年龄、性别和体重指数匹配的健康对照。所有参与者都进行了腰椎穿刺、视觉评估、详细的头痛表型和MRI-ICP扫描，以计算基线时的颅内依从性指数。治疗后，患者被邀请参加为期一年的访问，并重复所有评估。结果：IIH组颅内依从性指数（平均= 1006.0 cc/mmHg/cm, SD =±384.6 cc/mmHg/cm）较对照组（平均= 1493.0 cc/mmHg/cm, SD =±411.8 cc/mmHg/cm）显著降低（p = 0.017），与腰椎穿刺开口压力呈负相关（r = -0.502, p = 0.029）。依从性指数与头痛残疾呈显著负相关（r = -0.458, p = 0.049），依从性指数越低，头痛发病频率越高（r = -0.430, p = 0.066）。在考虑使用镇痛药后，后者变得显著（p = 0.018）。治疗成功后，所有患者的依从性指数在一年内均有所提高（平均差异= 380.7 cc/mmHg/cm, p = 0.031）。结论：这是首次将MRI-ICP技术纵向应用于IIH的研究。它说明IIH患者颅内依从性指数降低，与开口压力和头痛残疾相关，并随着治疗而改善。
Non-invasive assessment of intracranial compliance in idiopathic intracranial hypertension: an MRI-ICP study.
Background/objectives: Idiopathic intracranial hypertension (IIH) is a disease which threatens vision and causes disabling headaches, affecting women of childbearing age with obesity. It is characterised by raised intracranial pressure (ICP), measured invasively either with lumbar punctures or intracranially-inserted monitors. There is an unmet clinical need to develop non-invasive means to assess ICP. This study aims to utilise the MRI-ICP imaging technique to measure intracranial compliance index and assess its suitability as surrogate biomarker of ICP.
Subjects/methods: Nine IIH patients and ten age, sex, and body mass index matched healthy controls were recruited. All participants underwent lumbar puncture, visual assessments, detailed headache phenotyping, and MRI-ICP scans to calculate intracranial compliance index at baseline. Following treatment, patients were invited to attend a one-year visit when all assessments were repeated.
Results: There was significant (p = 0.017) reduction in intracranial compliance index in IIH (mean = 1006.0 cc/mmHg/cm, SD = ± 384.6 cc/mmHg/cm) compared to controls (mean = 1493.0 cc/mmHg/cm, SD = ± 411.8 cc/mmHg/cm), inversely correlating with lumbar puncture opening pressure (r = -0.502, p = 0.029). A significant inverse correlation between compliance index and headache disability was also found (r = -0.458, p = 0.049) and a trend for an association between lower compliance index and increased frequency of headaches (r = -0.430, p = 0.066). This latter became significant (p = 0.018) after accounting for use of analgesics. Following successful treatment, compliance index was increased in all patients at one year (mean of differences = 380.7 cc/mmHg/cm, p = 0.031).
Conclusions: This is the first study to apply the MRI-ICP technique longitudinally in IIH. It illustrates reduced intracranial compliance index in IIH, correlating with opening pressure and headache disability and ameliorating with treatment.
期刊介绍：
Eye seeks to provide the international practising ophthalmologist with high quality articles, of academic rigour, on the latest global clinical and laboratory based research. Its core aim is to advance the science and practice of ophthalmology with the latest clinical- and scientific-based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science worldwide. Eye is the official journal of The Royal College of Ophthalmologists.
Eye encourages the submission of original articles covering all aspects of ophthalmology including: external eye disease; oculo-plastic surgery; orbital and lacrimal disease; ocular surface and corneal disorders; paediatric ophthalmology and strabismus; glaucoma; medical and surgical retina; neuro-ophthalmology; cataract and refractive surgery; ocular oncology; ophthalmic pathology; ophthalmic genetics.
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