ABSTRACT
PURPOSE: Aim of this study was to develop quantitative parameters for diagnosing Idiopathic Intracranial Hypertension (IIH) using brain MRI scans. METHODS: This is a case control study with 48 cases and 192 matched controls. Optic nerve diameter (OND), Pituitary height (PH), Meckel's cave diameter (MCD), and Neck fat thickness (NFT) were measured for both groups. Consequently, means were obtained for the different parameters in both groups with subsequent establishment of best cutoffs using Receiver Operator Curve (ROC) analysis. RESULTS: For IIH patients the means of OND, PH, MCD, and NFT were 6.2 mm, 3.9 mm, 5 mm, 1.4 cm, respectively while for controls the means were 4.6 mm, 4.5 mm, 4.3 mm, and 0.8 cm with statistical significance between the two groups. ROC analysis showed the cutoff points with best accuracy for the above parameters in diagnosing IIH to be 5.4 mm for OND with sensitivity of 0.77 and specificity of 0.85 representing high accuracy, while for PH a cutoff point of 3 mm showed low accuracy with sensitivity of 0.54 and specificity of 0.7, and a MCD cutoff of 4.5 mm also showed low accuracy with sensitivity of 0.6 and specificity of 0.59, meanwhile a cutoff point of 1.1 cm for NFT was moderately accurate with sensitivity of 0.70 and specificity of 0.81. CONCLUSION: Statistical difference in the means for OND, PH, MCD, and NFT between IIH patients and controls is established. Also, we provide cut off points for these parameters to diagnose IIH on brain MRI.
ABSTRACT
BACKGROUND Hemosiderotic synovitis (HS) is a rare proliferative synovial disorder with incompletely understood pathophysiology. It mainly affects the knee joint. It can be confused with pigmented villonodular synovitis (PVNS), both clinically and radiologically. HS has not been previously reported in children, and this rare incidence may lead to difficulties in early clinical and radiological diagnosis, possibly affecting the patient's outcome. CASE REPORT A 13-year-old boy presented with progressive right knee pain, swelling, and limitation of movement 2 months after a traumatic injury in a soccer game. His past medical and family history was unremarkable. His physical exam showed right knee effusion, fullness in the popliteal fossa, and painful restriction in active and passive knee motion. Laboratory tests showed a mildly elevated erythrocyte sedimentation rate. Knee X-rays showed joint effusion. Knee MRI showed large knee joint effusion with diffuse low signal intensity villous synovial hypertrophy in all sequences in addition to a large popliteal cyst with the same imaging characteristics, consistent with diffuse-form PVNS. Total arthroscopic synovectomy was performed without complications. Intraoperatively, there was a large effusion containing yellow clots. The histopathological diagnosis was post-traumatic HS with no evidence of PVNS or malignancy. The patient showed significant clinical and radiological improvement postoperatively with no evidence of recurrence. CONCLUSIONS Post-traumatic HS is a very rare entity that should always be considered in the differential diagnosis of synovitis in active, non-hemophilic children. Radiologists' familiarity with this rare condition is important to guide correct and early diagnosis, and to avoid unnecessary invasive intervention.
