Geniculate ganglion diverticulum: a potential imaging marker in patients with idiopathic intracranial hypertension

Sachin Chitalkar, Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America. Electronic address: sachinc@gwu.edu.
Dipak Thakor, Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America. Electronic address: dthakor@chuildrensnational.org.
Ali Sheikhy, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: sheikhyali@yahoo.com.
Jamie Cole, George Washington University School of Medicine & Health Sciences, 2300 I St NW, Washington, DC 20052, United States of America.
Sarah Fangmeyer, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America. Electronic address: sfangmeyer@mfa.gwu.edu.
Fatemeh Nasri, Division of Neuroradiology, George Washington University School of Medicine & Health Sciences, 900 23rd St NW 2nd Floor, Washington, DC 20037, United States of America.
Abdelmonem Ahmed, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America.
Ashkan Monfared, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America. Electronic address: amonfared@mfa.gwu.edu.
Md Reza Taheri, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW 4th floor, Washington, DC 20037, United States of America. Electronic address: rtaheri@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

9-11-2024

Journal

Clinical imaging

Volume

115

DOI

10.1016/j.clinimag.2024.110278

Abstract

PURPOSE: The diagnosis of idiopathic intracranial hypertension (IIH) is often challenging in patients who do not present with classic symptoms. Brain MRI can play a pivotal role, as several imaging findings, such as an empty sella appearance (ESA), have been shown to be associated with IIH. Yet, none of the MRI signs have been shown to have a high sensitivity and specificity. In this study, we tested the hypothesis that presence of a geniculate ganglion diverticulum (GGD) is a potential imaging marker for the detection of IIH. MATERIALS AND METHODS: This is an IRB-approved, single-institution, retrospective, observational study. Brain MRI examinations of patients referred to Radiology by Otology clinic over a period of 10 years were reviewed. 244 MRI exams fulfilling inclusion and exclusion criteria were independently screened for the presence of GGD and ESA by two Neuroradiology fellows. Electronic medical records (EMR) of patients in this study were reviewed for presence of clinical manifestations of IIH. Receiver operator characteristic (ROC) curves were generated to estimate the accuracy of each covariate in diagnosing IIH. The area under each ROC curve (AUC) was calculated to identify an accurate prognostic covariate. Statistical analysis was done using R programming language V 4.2.2. RESULTS: GGD was identified in MRI exams of 51 patients. A 2:1 propensity score (PS) matching for age, gender, and Body Mass Index (BMI) was used to select non-GGD control group for comparison with the GGD group. There was strong agreement between the 2 reviewers (kappa = 0.81, agreement = 95 %). Twelve patients in this study were diagnosed with IIH. There was a high incidence of GGD (OR = 12.19, 95 % CI (2.56, 58.10)) and ESA (OR = 4.97, 95 % CI (1.47, 16.74)) in IIH patients. The AUC observed in GGD for predicting IIH was 0.771 (0.655-0.888), specificity = 0.709 (0.638-0.780), and sensitivity = 0.833 (0.583-1). The AUC observed for ESA in predicting IIH was 0.682 (0.532-0.831), specificity = 0.780 (0.709-0.844), and sensitivity = 0.583 (0.333-0.833). CONCLUSION: GGD is potentially a novel imaging marker of IIH with sensitivity higher than and specificity comparable to that of ESA. CLINICAL RELEVANCE STATEMENT: Presence of GGD should raise the possibility of IIH.

Department

Radiology

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