Interpretation of increased intracranial pressure findings on brain magnetic resonance imaging in headache patients.

PURPOSE: The aim of this study was to investigate the prevalence of imaging findings indicative of increased intracranial pressure (ICP) on brain magnetic resonance imaging (MRI) in patients presenting with headache, their association with demographic characteristics, and their performance in predicting idiopathic intracranial hypertension (IIH). METHODS: Brain MRIs of 265 patients with headache were evaluated for the presence of empty sella, optic nerve tortuosity, optic nerve sheath dilatation, posterior globe flattening, Meckel's cave enlargement, and tonsillar ectopia. The prevalence of these findings was assessed, and their associations with demographic characteristics and IIH were analyzed. RESULTS: At least one MRI finding suggestive of increased ICP was identified in 52.8% of the patients. The prevalence of all parameters was statistically significantly higher in patients with IIH compared to those with other types of headache. Meckel's cave enlargement and tonsillar ectopia were not influenced by demographic characteristics, whereas significant associations were observed between demographic features and the other parameters. In receiver operating characteristic (ROC) curve analyses, empty sella, optic nerve sheath dilatation, optic nerve tortuosity, and posterior globe flattening demonstrated moderate to good discriminative ability for IIH. In univariate logistic regression analyses, all findings were associated with IIH; however, in multivariate logistic regression analyses, empty sella, posterior globe flattening, and tonsillar ectopia emerged as statistically significant predictors. CONCLUSION: Although ICP findings seen on brain MRI are not always associated with IIH, MRI has the potential to improve the accuracy of IIH diagnosis.