Relationship Between Optic Nerve Protrusion Measured by OCT and MRI and Papilledema Severity

Chang, Yeon S.; Alperin, Noam; Bagci, Ahmet; Lee, Sang H.; Rosa, Potyra R.; Gregori, Giovanni; Lam, Byron L.

doi:10.1167/iovs.15-16602

Cited by 17 publications

(13 citation statements)

References 30 publications

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“…We and other authors have shown that size/volume of the ONH and thickness of the retinal nerve fiber layer (RNFL) can be increased even in subtle IIH without papilledema (IIHWOP). OCT measures are correlated with cerebrospinal fluid (CSF) pressure and Frisén grading of papilledema . In contrast to CSF pressure measure and fundus assessment, OCT is a non‐invasive, sensitive and objective in‐vivo method.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Huang‐Link

Eleftheriou

Yang

et al. 2019

Euro J of Neurology

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Background and purpose We previously reported that certain optical coherence tomography (OCT) measures were sensitive and reliable in identifying idiopathic intracranial hypertension (IIH). This prospective study aimed to define OCT measures that allow differentiation of IIH with and without papilledema, thereby helping clinical decision‐making. Methods Eight patients with IIH with papilledema, nine without papilledema and 19 with other neurological diseases were included. OCT measures were obtained before lumbar puncture and within 2 h, 1, 3 and 6 months after lumbar puncture with cerebrospinal fluid (CSF) removal. Results All patients with papilledema had increased retinal nerve fiber layer (RNFL) thickness and elevated CSF pressure. All patients without papilledema had normal RNFL but elevated CSF pressure. After CSF removal, reduced RNFL thickness was registered in all eight patients with IIH with papilledema. No significant change in RNFL thickness after CSF removal was observed in IIH without papilledema or in patients with other neurological diseases, although reduced CSF pressure was documented. RNFL thickness tended to be normal in patients with IIH with papilledema at 3–6 months after CSF removal. All patients with IIH showed increased rim area and rim thickness, but reduced optic cup volume regardless of RNFL thickness or papilledema. Conclusions Retinal nerve fiber layer thickness is sensitive for monitoring acute IIH and evaluating treatment effect. Increased rim area and rim thickness and decreased optic cup volume are reliable parameters that indicate persistently increased CSF pressure and risk of relapse. OCT measures are sensitive and reliable for diagnosing subtle IIH even in the absence of papilledema.

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Section: Introductionmentioning

confidence: 99%

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Huang‐Link

Eleftheriou

Yang

et al. 2019

Euro J of Neurology

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“…These include swelling of the optic nerve head due to axoplasmic flow stasis, which is an important diagnostic sign for increased ICP, (1) globe flattening, peripapillary deformation and expansion of the optic nerve sheath, all presumably due to mechanical pressure of the CSF in the nerve sheath. Ophthalmic and neuro-images of the optic nerve and surrounding globe have demonstrated differences in optic nerve head volume (ONHV), globe flattening, and peripapillary Bruch's membrane displacement (pBMd) between high and normal ICP states, and, on this basis they are candidates as diagnostic markers of high ICP states (2–5).…”

Section: Introductionmentioning

confidence: 99%

Methods for Quantifying Optic Disc Volume and Peripapillary Deflection Volume Using Radial Optical Coherence Tomography Scans and Association With Intracranial Pressure

et al. 2019

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Purpose: Papilledema and peripapillary deformation of Bruch's membrane (BM) are associated with elevated intracranial pressure (ICP). We have developed a novel methodology to measure these parameters using a radial optical coherence tomography (OCT) scan pattern and apply this to test the hypothesis that ICP is associated with volumetric features of ophthalmic structures. Methods: 6-radial OCT B-scans centered over the optic nerve head were acquired in 17 subjects (30 eyes) before lumbar puncture with measurement of ICP (range: 10–55 cm H 2 O). Internal limiting membrane (ILM) and BM were segmented. Three definitions of BM were studied to account for imaging artifact affecting peripapillary BM: connecting rater-identified BM margins(traditional), connecting rater-identified BM 1.6 mm on either side of the ONH(estimated), and excluding BM in the central 3.2 mm of the images(excluded). Optic nerve head volume (ONHV), BM displacement volume (BMDV) and cup volume (CV) were calculated by interpolating between B-scans. Ganglion cell complex volume (GCCV) was measured in the macula. Linear generalized estimating equations (GEE) modeled ONVH, BMDV, and CV as a function of ICP and GCCV. Results: Increased ONHV was associated with elevated ICP for traditional ( p = 0.006), estimated ( p = 0.003) and excluded ( p = 0.05) BM definitions. Decreased BMDV was associated with elevated ICP for traditional ( p < 0.0005), estimated ( p < 0.0005) and excluded ( p = 0.001) definitions. Decreased ONHV was independently associated with decreased GCCV ( p = 0.001) and decreased ICP ( p = 0.031) in multivariable models. CV was neither associated with ICP nor GCCV in univariate or multivariable models. Conclusions: Elevated ICP is associated with ONHV increase and BMDV decrease, calculated from OCT images accounting for image artifact. Ganglion cell atrophy affects the relationship between ICP and ONHV. OCT derived volumetric measures of the posterior eye may have application as biomarkers for elevated ICP.

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“…Common MRI findings of papilledema include (1) enlargement of the optic nerve sheath, (2) flattening of the posterior sclera, (3) protrusion of the papilla into the globe, and (4) optic nerve tortuosity (Fig 1). 1–3,12–16 Although raised ICP and papilledema are diagnosed clinically, further delineating the globes, optic nerves, and optic nerve sheaths should be achieved using dedicated orbital scans, particularly in suspected IIH. Imaging has become recognized for its role in the diagnosis of IIH, with its typical signs, and not only for exclusion of other pathologies 15 .…”

Section: Mri Of the Orbitsmentioning

confidence: 99%

Neuroimaging in Children with Ophthalmological Complaints: A Review

Rootman

Dotan

Konen

2021

Journal of Neuroimaging

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Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat‐suppressed T2‐weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.

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Relationship Between Optic Nerve Protrusion Measured by OCT and MRI and Papilledema Severity

Cited by 17 publications

References 30 publications

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema

Methods for Quantifying Optic Disc Volume and Peripapillary Deflection Volume Using Radial Optical Coherence Tomography Scans and Association With Intracranial Pressure

Neuroimaging in Children with Ophthalmological Complaints: A Review

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