B-Mode Transorbital Ultrasonography for the Diagnosis of Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

Abstract

In patients with idiopathic intracranial hypertension (IIH), transorbital sonography (TOS) may reveal an enlargement of the optic nerve sheath diameter (ONSD) and the presence of optic disc elevation (ODE), as a sign of an increase in intracranial pressure (ICP). We systematically reviewed the TOS findings in adults with IIH. MEDLINE, EMBASE, Cochrane Library and CENTRAL (1966 – May 2017) were searched to identify studies reporting data on patients with IIH assessed by B mode-TOS. Data were extracted and included in a meta-analysis, and the quality of the included studies was evaluated. 5 studies with 96 patients were included. The values of ODE were 0.8 – 1.2 mm and ONSD was 6.2 – 6.76 mm in IIH patients vs. 4.3 – 5.7 mm in controls. In IIH patients the ONSD was significantly higher compared to controls (overall weighted mean difference of 1.3 mm (95 % CI: 0.6 – 1.9 mm)). The meta-analysis of proportion of papilledema based on results of three studies revealed a pooled estimator of 87 % (95 % CI: 76 – 94 %). IIH patients have higher ONSD values and higher frequency of ODE compared to controls. The indirect, noninvasive ICP assessment using TOS may be useful in supporting the clinical diagnosis of IIH in adults by detecting increased ONSD values and the presence of ODE.

Zusammenfassung

Bei Patienten mit idiopathischer intrakranieller Hypertension (IIH) kann die transorbitale Sonografie (TOS) eine Vergrößerung des Optikusnervenscheiden-Durchmessers (ONSD) und die Anwesenheit eines Papillen-Ödems (ODE) als Zeichen eines erhöhten intrakraniellen Drucks (ICP) aufzeigen. Wir bewerteten die TOS-Befunde bei Erwachsenen mit IIH systematisch. Durchsucht wurden MEDLINE, EMBASE, Cochrane Library und CENTRAL (1966 – Mai 2017) nach Studien, in denen Daten von IIH-Patienten mittels B-Bild-TOS erhoben wurden. Diese Daten wurden extrahiert und in eine Meta-Analyse eingeschlossen; die Qualität der eingeschlossenen Studien wurde evaluiert. 5 Studien mit 96 Patienten wurden eingeschlossen. Die Werte des Papillen-Ödems betrugen 0,8 – 1,2 mm, und die ONSD-Werte bei Patienten mit IIH betrugen 6,2 – 6,76 mm gegenüber 4,3 – 5,7 mm bei den Kontrollen. Bei IIH-Patienten waren die ONSD-Werte signifikant höher im Vergleich zu den Kontrollen (über alles gewichtete mittlere Differenz von 1,3 mm (95 %-KI: 0,6 – 1,9 mm)). Die Meta-Analyse zum Verhältnis des Papillen-Ödems basierend auf 3 Studien ergab einen gepoolten Schätzer von 87 % (95 %-Kl: 76 – 94 %). IIH-Patienten wiesen im Vergleich zu den Kontrollen höhere ONSD-Werte und häufiger eine ODE auf. Die indirekte, nichtinvasive Beurteilung von ICP mittels TOS könnte durch das Feststellen erhöhter ONSD-Werte und das Vorhandensein einer ODE bei der klinischen Diagnosestellung von IIH bei Erwachsenen nützlich sein.

Key words

idiopathic intracranial hypertension - intracranial pressure - optic disc elevation - optic nerve sheath diameter - transorbital sonography

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