Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema

Melinda Y Chang, Federico G. Velez, Joseph L. Demer, Laura Bonelli, Peter A. Quiros, Anthony C. Arnold, Alfredo A. Sadun, Stacy L. Pineles

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose To identify the most accurate diagnostic imaging modality for classifying pediatric eyes as papilledema (PE) or pseudopapilledema (PPE). Design Prospective observational study. Subjects Nineteen children between the ages of 5 and 18 years were recruited. Five children (10 eyes) with PE, 11 children (19 eyes) with PPE owing to suspected buried optic disc drusen (ODD), and 3 children (6 eyes) with PPE owing to superficial ODD were included. Methods All subjects underwent imaging with B-scan ultrasonography, fundus photography, autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and volumetric OCT scans through the optic nerve head with standard spectral-domain (SD OCT) and enhanced depth imaging (EDI OCT) settings. Images were read by 3 masked neuro-ophthalmologists, and the final image interpretation was based on 2 of 3 reads. Image interpretations were compared with clinical diagnosis to calculate accuracy and misinterpretation rates of each imaging modality. Main Outcome Measures Accuracy of each imaging technique for classifying eyes as PE or PPE, and misinterpretation rates of each imaging modality for PE and PPE. Results Fluorescein angiography had the highest accuracy (97%, 34 of 35 eyes, 95% confidence interval 92%–100%) for classifying an eye as PE or PPE. FA of eyes with PE showed leakage of the optic nerve, whereas eyes with suspected buried ODD demonstrated no hyperfluorescence, and eyes with superficial ODD showed nodular staining. Other modalities had substantial likelihood (30%–70%) of misinterpretation of PE as PPE. Conclusions The best imaging technique for correctly classifying pediatric eyes as PPE or PE is FA. Other imaging modalities, if used in isolation, are more likely to lead to misinterpretation of PE as PPE, which could potentially result in failure to identify a life-threatening disorder causing elevated intracranial pressure and papilledema.

Original languageEnglish (US)
Pages (from-to)1839-1848
Number of pages10
JournalOphthalmology
Volume124
Issue number12
DOIs
StatePublished - Dec 1 2017

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Papilledema
Diagnostic Imaging
Pediatrics
Optic Disk Drusen
Fluorescein Angiography
Optical Coherence Tomography
Pseudopapilledema
Intracranial Hypertension
Photography
Optic Disk
Optic Nerve
Nerve Fibers
Observational Studies
Ultrasonography
Outcome Assessment (Health Care)
Prospective Studies
Confidence Intervals
Staining and Labeling

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Chang, M. Y., Velez, F. G., Demer, J. L., Bonelli, L., Quiros, P. A., Arnold, A. C., ... Pineles, S. L. (2017). Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema. Ophthalmology, 124(12), 1839-1848. https://doi.org/10.1016/j.ophtha.2017.06.016

Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema. / Chang, Melinda Y; Velez, Federico G.; Demer, Joseph L.; Bonelli, Laura; Quiros, Peter A.; Arnold, Anthony C.; Sadun, Alfredo A.; Pineles, Stacy L.

In: Ophthalmology, Vol. 124, No. 12, 01.12.2017, p. 1839-1848.

Research output: Contribution to journalArticle

Chang, MY, Velez, FG, Demer, JL, Bonelli, L, Quiros, PA, Arnold, AC, Sadun, AA & Pineles, SL 2017, 'Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema', Ophthalmology, vol. 124, no. 12, pp. 1839-1848. https://doi.org/10.1016/j.ophtha.2017.06.016
Chang, Melinda Y ; Velez, Federico G. ; Demer, Joseph L. ; Bonelli, Laura ; Quiros, Peter A. ; Arnold, Anthony C. ; Sadun, Alfredo A. ; Pineles, Stacy L. / Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema. In: Ophthalmology. 2017 ; Vol. 124, No. 12. pp. 1839-1848.
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abstract = "Purpose To identify the most accurate diagnostic imaging modality for classifying pediatric eyes as papilledema (PE) or pseudopapilledema (PPE). Design Prospective observational study. Subjects Nineteen children between the ages of 5 and 18 years were recruited. Five children (10 eyes) with PE, 11 children (19 eyes) with PPE owing to suspected buried optic disc drusen (ODD), and 3 children (6 eyes) with PPE owing to superficial ODD were included. Methods All subjects underwent imaging with B-scan ultrasonography, fundus photography, autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and volumetric OCT scans through the optic nerve head with standard spectral-domain (SD OCT) and enhanced depth imaging (EDI OCT) settings. Images were read by 3 masked neuro-ophthalmologists, and the final image interpretation was based on 2 of 3 reads. Image interpretations were compared with clinical diagnosis to calculate accuracy and misinterpretation rates of each imaging modality. Main Outcome Measures Accuracy of each imaging technique for classifying eyes as PE or PPE, and misinterpretation rates of each imaging modality for PE and PPE. Results Fluorescein angiography had the highest accuracy (97{\%}, 34 of 35 eyes, 95{\%} confidence interval 92{\%}–100{\%}) for classifying an eye as PE or PPE. FA of eyes with PE showed leakage of the optic nerve, whereas eyes with suspected buried ODD demonstrated no hyperfluorescence, and eyes with superficial ODD showed nodular staining. Other modalities had substantial likelihood (30{\%}–70{\%}) of misinterpretation of PE as PPE. Conclusions The best imaging technique for correctly classifying pediatric eyes as PPE or PE is FA. Other imaging modalities, if used in isolation, are more likely to lead to misinterpretation of PE as PPE, which could potentially result in failure to identify a life-threatening disorder causing elevated intracranial pressure and papilledema.",
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