{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:08:24Z","timestamp":1793102904738,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The magnetic resonance imaging (MRI) criteria currently used to diagnose idiopathic intracranial hypertension (IIH) are based on expert opinion and have limited accuracy. Additional neuroimaging signs have been proposed and used with contradictory results; thus, prospective evidence is needed to improve diagnostic accuracy.<\/jats:p><\/jats:sec>Objective<\/jats:title>To provide evidence-based, accurate MRI signs for IIH diagnosis.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective cohort study was conducted from January 2018 to May 2021 with 3 validation cohorts at 2 Danish headache centers and with 3 independent international cohorts. Consecutive patients with suspected IIH were enrolled. Eligibility required the clinical suspicion of IIH, age 18 years or older, and written informed consent. The validation cohorts comprised patients with confirmed IIH from Austria and the US, and patients without IIH from the US. Data analysis was performed from December 2021 to August 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Standardized diagnostic workup was performed to classify cases according to current criteria, and blinded evaluation of cerebral radiological diagnostics and papilledema was performed.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were MRI signs associated with IIH as assessed by univariate analyses. An MRI score estimating papilledema was calculated using machine learning. Internal validation of associations with lumbar puncture opening pressure and outcome and external validation of accuracy were performed in 3 cohorts.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 192 eligible patients (185 women [96.4%]; median [IQR] age, 28.0 [23.0-35.0] years), 110 were classified as having IIH, 4 as having probable IIH, and 1 as having suspected IIH without papilledema; 77 did not have IIH and served as controls, with corresponding age, sex, and weight. Papilledema at diagnosis was associated with perioptic subarachnoid space distension (56 patients [68.3%] vs 21 patients [41.2%]), posterior globe flattening (53 patients [66.3%] vs 10 patients [21.3%]), optic nerve disc protrusion (35 patients [30.4%] vs 2 patients [2.3%]), and transverse sinus venous stenosis (75 patients [79.8%] vs 29 patients [46.8%]). The papilledema-estimating MRI score showed optimal balance between sensitivity (49%) and specificity (87%) when 2 of the 3 latter signs were present and was associated with the lumbar puncture opening pressure and ophthalmological outcome. The score showed strong diagnostic accuracy in the external validation cohorts (587 patients; area under the receiver operating characteristic curve,\u20090.86) and outperformed the current (2013) diagnostic MRI criteria.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study of patients with IIH and controls suggest that an evidence-based MRI score including posterior globe flattening, optic nerve disc protrusion, and transverse sinus stenosis can estimate the presence of papilledema more accurately than the current diagnostic criteria.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.20138","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T15:06:49Z","timestamp":1720019209000},"page":"e2420138","source":"Crossref","is-referenced-by-count":56,"title":["Magnetic Resonance Imaging Signs of Idiopathic Intracranial 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Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiangkuo","family":"Yuan","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areeba","family":"Nisar","sequence":"additional","affiliation":[{"name":"Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbeth","family":"H\u00f8gedal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laleh Dehghani","family":"Molander","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snorre Malm","family":"Hagen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph Patrick","family":"Beier","sequence":"additional","affiliation":[{"name":"Department of Neurology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, Odense, Denmark"},{"name":"OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon Bang","family":"Kristensen","sequence":"additional","affiliation":[{"name":"OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark"},{"name":"Department of Public Health\u2013Biostatistics, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigmor H\u00f8jland","family":"Jensen","sequence":"additional","affiliation":[{"name":"Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"issue":"3","key":"zoi240649r1","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1038\/s41433-018-0238-5","article-title":"The expanding burden of idiopathic intracranial hypertension.","volume":"33","author":"Mollan","year":"2019","journal-title":"Eye (Lond)"},{"issue":"8","key":"zoi240649r2","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1001\/archneur.1988.00520320065016","article-title":"The incidence of pseudotumor cerebri: population studies in Iowa and Louisiana.","volume":"45","author":"Durcan","year":"1988","journal-title":"Arch 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