Utility of Ultrasound and Optical Coherence Tomography in Differentiating Between Papilledema and Pseudopapilledema in Children.
Journal
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
ISSN: 1536-5166
Titre abrégé: J Neuroophthalmol
Pays: United States
ID NLM: 9431308
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
20
4
2021
medline:
19
3
2022
entrez:
19
4
2021
Statut:
ppublish
Résumé
Differentiating between papilledema and pseudopapilledema in children presenting with mild-to-moderate optic nerve head elevation is challenging. This study sought to determine which B-scan ultrasonography (BSUS) and optical coherence tomography (OCT) features, individually or in combination, are best able to differentiate between papilledema and pseudopapilledema in children. Children presenting with optic nerve head elevation of unknown etiology were eligible if they underwent BSUS and OCT performed by the same investigator. The absolute optic nerve sheath diameter (in millimeter) along with the presence/absence of a hyperreflective nodule(s) at the optic nerve head (indicative of druse) from BSUS was determined. The average circumpapillary retinal nerve fiber layer (cpRNFL), diameter of Bruch membrane opening, maximum papillary height, and the presence/absence of hyper-/hyporeflective lesions at the optic nerve head were calculated. Sensitivity and specificity were calculated to evaluate which BSUS and OCT imaging features, individually and in combination, accurately classified children as having papilledema vs pseudopapilledema. One hundred eighty-one eyes from 94 children (mean age, 11.0 years; range, 3.2-17.9) were included; 36 eyes with papilledema and 145 eyes with pseudopapilledema. Among BSUS features, optic nerve sheath widening (>4.5 mm) demonstrated the best sensitivity (86%; 95% confidence interval [CI], 64%-96%) and specificity (88%; 95% CI, 79%-94%) for papilledema. Among OCT measures, cpRNFL thickness of ≥140 µm demonstrated the best sensitivity (83%; 95% CI, 66%-93%) and specificity (76%; 95% CI, 66%-84%) to identify papilledema. The presence of both optic nerve sheath widening (>4.5 mm) and cpRNFL thickness of ≥140 µm reduced the sensitivity (72%; 95% CI, 52%-86%) but increased specificity (95%; 95% CI, 88%-98%). BSUS (optic nerve sheath widening [>4.5 mm]) and OCT (cpRNFL thickness ≥140 µm), individually and collectively, have good diagnostic accuracy for differentiating between papilledema and pseudopapilledema. The presence of druse does not exclude the diagnosis of papilledema.
Sections du résumé
BACKGROUND
Differentiating between papilledema and pseudopapilledema in children presenting with mild-to-moderate optic nerve head elevation is challenging. This study sought to determine which B-scan ultrasonography (BSUS) and optical coherence tomography (OCT) features, individually or in combination, are best able to differentiate between papilledema and pseudopapilledema in children.
METHODS
Children presenting with optic nerve head elevation of unknown etiology were eligible if they underwent BSUS and OCT performed by the same investigator. The absolute optic nerve sheath diameter (in millimeter) along with the presence/absence of a hyperreflective nodule(s) at the optic nerve head (indicative of druse) from BSUS was determined. The average circumpapillary retinal nerve fiber layer (cpRNFL), diameter of Bruch membrane opening, maximum papillary height, and the presence/absence of hyper-/hyporeflective lesions at the optic nerve head were calculated. Sensitivity and specificity were calculated to evaluate which BSUS and OCT imaging features, individually and in combination, accurately classified children as having papilledema vs pseudopapilledema.
RESULTS
One hundred eighty-one eyes from 94 children (mean age, 11.0 years; range, 3.2-17.9) were included; 36 eyes with papilledema and 145 eyes with pseudopapilledema. Among BSUS features, optic nerve sheath widening (>4.5 mm) demonstrated the best sensitivity (86%; 95% confidence interval [CI], 64%-96%) and specificity (88%; 95% CI, 79%-94%) for papilledema. Among OCT measures, cpRNFL thickness of ≥140 µm demonstrated the best sensitivity (83%; 95% CI, 66%-93%) and specificity (76%; 95% CI, 66%-84%) to identify papilledema. The presence of both optic nerve sheath widening (>4.5 mm) and cpRNFL thickness of ≥140 µm reduced the sensitivity (72%; 95% CI, 52%-86%) but increased specificity (95%; 95% CI, 88%-98%).
CONCLUSION
BSUS (optic nerve sheath widening [>4.5 mm]) and OCT (cpRNFL thickness ≥140 µm), individually and collectively, have good diagnostic accuracy for differentiating between papilledema and pseudopapilledema. The presence of druse does not exclude the diagnosis of papilledema.
Identifiants
pubmed: 33870950
doi: 10.1097/WNO.0000000000001248
pii: 00041327-202112000-00010
pmc: PMC8514567
mid: NIHMS1673569
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
488-495Subventions
Organisme : NEI NIH HHS
ID : P30 EY001583
Pays : United States
Informations de copyright
Copyright © 2021 by North American Neuro-Ophthalmology Society.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Malmqvist L, Bursztyn L, Costello F, Digre K, Fraser JA, Fraser C, Katz B, Lawlor M, Petzold A, Sibony P, Warner J, Wegener M, Wong S, Hamann S. The optic disc drusen studies consortium recommendations for diagnosis of optic disc drusen using optical coherence tomography. J Neuroophthalmol. 2018;38:299–307.
Malmqvist L, Sibony PA, Fraser CL, Wegener M, Heegaard S, Skougaard M, Hamann S. Peripapillary ovoid hyperreflectivity in optic disc edema and pseudopapilledema. Ophthalmology. 2018;125:1662–1664.
Bhosale A, Shah VM, Shah PK. Accuracy of crescent sign on ocular ultrasound in diagnosing papilledema. World J Methodol. 2017;7:108–111.
Boldt HC, Byrne SF, DiBernardo C. Echographic evaluation of optic disc drusen. J Clin Neuroophthalmol. 1991;11:85–91.
Carter SB, Pistilli M, Livingston KG, Gold DR, Volpe NJ, Shindler KS, Liu GT, Tamhankar MA. The role of orbital ultrasonography in distinguishing papilledema from pseudopapilledema. Eye (Lond). 2014;28:1425–1430.
Kurz-Levin MM, Landau K. A comparison of imaging techniques for diagnosing drusen of the optic nerve head. Arch Ophthalmol. 1999;117:1045–1049.
Mehrpour M, Oliaee Torshizi F, Esmaeeli S, Taghipour S, Abdollahi S. Optic nerve sonography in the diagnostic evaluation of pseudopapilledema and raised intracranial pressure: a cross-sectional study. Neurol Res Int. 2015;2015:146059.
Neudorfer M, Ben-Haim MS, Leibovitch I, Kesler A. The efficacy of optic nerve ultrasonography for differentiating papilloedema from pseudopapilloedema in eyes with swollen optic discs. Acta Ophthalmol. 2013;91:376–380.
Birnbaum FA, Johnson GM, Johnson LN, Jun B, Machan JT. Increased prevalence of optic disc drusen after papilloedema from idiopathic intracranial hypertension: on the possible formation of optic disc drusen. Neuroophthalmology. 2016;40:171–180.
Malmqvist L, Li XQ, Eckmann CL, Skovgaard AM, Olsen EM, Larsen M, Munch IC, Hamann S. Optic disc drusen in children: the copenhagen child cohort 2000 eye study. J Neuroophthalmol. 2018;38:140–146.
Malmqvist L, Lund-Andersen H, Hamann S. Long-term evolution of superficial optic disc drusen. Acta Ophthalmol. 2017;95:352–356.
Fard MA, Okhravi S, Moghimi S, Subramanian PS. Optic nerve head and macular optical coherence tomography measurements in papilledema compared with pseudopapilledema. J Neuroophthalmol. 2019;39:28–34.
Chang MY, Velez FG, Demer JL, Bonelli L, Quiros PA, Arnold AC, Sadun AA, Pineles SL. Accuracy of diagnostic imaging modalities for classifying pediatric eyes as papilledema versus pseudopapilledema. Ophthalmology. 2017;124:1839–1848.
Fard MA, Fakhree S, Abdi P, Hassanpoor N, Subramanian PS. Quantification of peripapillary total retinal volume in pseudopapilledema and mild papilledema using spectral-domain optical coherence tomography. Am J Ophthalmol. 2014;158:136–143.
Gampa A, Vangipuram G, Shirazi Z, Moss HE. Quantitative association between peripapillary Bruch's membrane shape and intracranial PressureICP and peripapillary Bruch's membrane shape. Invest Ophthalmol Vis Sci. 2017;58:2739–2745.
Karam EZ, Hedges TR. Optical coherence tomography of the retinal nerve fibre layer in mild papilloedema and pseudopapilloedema. Br J Ophthalmol. 2005;89:294–298.
Kulkarni KM, Pasol J, Rosa PR, Lam BL. Differentiating mild papilledema and buried optic nerve head drusen using spectral domain optical coherence tomography. Ophthalmology. 2014;121:959–963.
Merchant KY, Su D, Park SC, Qayum S, Banik R, Liebmann JM, Ritch R. Enhanced depth imaging optical coherence tomography of optic nerve head drusen. Ophthalmology. 2013;120:1409–1414.
Thompson AC, Bhatti MT, El-Dairi MA. Bruch's membrane opening on optical coherence tomography in pediatric papilledema and pseudopapilledema. J AAPOS. 2018;22:38–43.e3.
Vartin C V, Nguyen AM, Balmitgere T, Bernard M, Tilikete C, Vighetto A. Detection of mild papilloedema using spectral domain optical coherence tomography. Br J Ophthalmol. 2012;96:375–379.
Green RL, Frazier SF. Ultrasound of the Eye and Orbit. 2nd edition. St. Louis, MO: Mosby Inc, 2002.
Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med. 2009;53:785–791.
Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, Dutton GN. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol. 1999;54:740–742.
Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–130.
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–1165.
Avery RA. Interpretation of lumbar puncture opening pressure measurements in children. J Neuroophthalmol. 2014;34:284–287.
Bassi ST, Mohana KP. Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen. Indian J Ophthalmol. 2014;62:1146–1151.
Johnson LN, Diehl ML, Hamm CW, Sommerville DN, Petroski GF. Differentiating optic disc edema from optic nerve head drusen on optical coherence tomography. Arch Ophthalmol. 2009;127:45–49.
Lee KM, Woo SJ, Hwang JM. Differentiation of optic nerve head drusen and optic disc edema with spectral-domain optical coherence tomography. Ophthalmology. 2011;118:971–977.
Sarac O, Tasci YY, Gurdal C, Can I. Differentiation of optic disc edema from optic nerve head drusen with spectral-domain optical coherence tomography. J Neuroophthalmol. 2012;32:207–211.
Dahlmann-Noor AH, Adams GW, Daniel MC, Davis A, Hancox J, Hingorani M, Ibanez P, McPhee B, Patel H, Restori M, Roberts C, Theodorou M, Acheson J. Detecting optic nerve head swelling on ultrasound and optical coherence tomography in children and young people: an observational study. Br J Ophthalmol. 2018;102:318–322.
Ghassibi MP, Chien JL, Abumasmah RK, Liebmann JM, Ritch R, Park SC. Optic nerve head drusen prevalence and associated factors in clinically normal subjects measured using optical coherence tomography. Ophthalmology. 2017;124:320–325.
Sato T, Mrejen S, Spaide RF. Multimodal imaging of optic disc drusen. Am J Ophthalmol. 2013;156:275–282.e1.
Slotnick S, Sherman J. Buried disc drusen have hypo-reflective appearance on SD-OCT. Optom Vis Sci. 2012;89:E704–E708.
Yi K, Mujat M, Sun W, Burnes D, Latina MA, Lin DT, Deschler DG, Rubin PA, Park BH, de Boer JF, Chen TC. Imaging of optic nerve head drusen: improvements with spectral domain optical coherence tomography. J Glaucoma. 2009;18:373–378.
Lee KM, Hwang JM, Woo SJ. Optic disc drusen associated with optic nerve tumors. Optom Vis Sci. 2015;92:S67–S75.
Lee KM, Woo SJ, Hwang JM. Morphologic characteristics of optic nerve head drusen on spectral-domain optical coherence tomography. Am J Ophthalmol. 2013;155:1139–e1.
Traber GL, Weber KP, Sabah M, Keane PA, Plant GT. Enhanced depth imaging optical coherence tomography of optic nerve head drusen: a comparison of cases with and without visual field loss. Ophthalmology. 2017;124:66–73.
Gospe SM, Bhatti MT, El-Dairi MA. Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. Br J Ophthalmol. 2016;100:505.