Tags

Type your tag names separated by a space and hit enter

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure.
Crit Care 2008; 12(5):R114CC

Abstract

INTRODUCTION

The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP.

METHODS

We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers. ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI. ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients.

RESULTS

Measurement of ONSD was possible in 95% of cases. The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 6.31 +/- 0.50 mm, 19 measures) than in those with ICP of 20 mmHg or less (5.29 +/- 0.48 mm, 26 measures; P < 0.0001) or in healthy volunteers (5.08 +/- 0.52 mm; P < 0.0001). There was a significant relationship between ONSD and ICP (r = 0.71, P < 0.0001). Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 0.94), with a best cut-off of 5.82 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 5.30 mm.

CONCLUSIONS

When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension.

Authors+Show Affiliations

University Division of Anaesthesia and Wolfson Brain Imaging Center, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, UK. thgeeraerts@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18786243

Citation

Geeraerts, Thomas, et al. "Use of T2-weighted Magnetic Resonance Imaging of the Optic Nerve Sheath to Detect Raised Intracranial Pressure." Critical Care (London, England), vol. 12, no. 5, 2008, pp. R114.
Geeraerts T, Newcombe VF, Coles JP, et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care. 2008;12(5):R114.
Geeraerts, T., Newcombe, V. F., Coles, J. P., Abate, M. G., Perkes, I. E., Hutchinson, P. J., ... Menon, D. K. (2008). Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Critical Care (London, England), 12(5), pp. R114. doi:10.1186/cc7006.
Geeraerts T, et al. Use of T2-weighted Magnetic Resonance Imaging of the Optic Nerve Sheath to Detect Raised Intracranial Pressure. Crit Care. 2008;12(5):R114. PubMed PMID: 18786243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. AU - Geeraerts,Thomas, AU - Newcombe,Virginia F J, AU - Coles,Jonathan P, AU - Abate,Maria Giulia, AU - Perkes,Iain E, AU - Hutchinson,Peter J A, AU - Outtrim,Jo G, AU - Chatfield,Dot A, AU - Menon,David K, Y1 - 2008/09/11/ PY - 2008/07/09/received PY - 2008/08/18/revised PY - 2008/09/11/accepted PY - 2008/9/13/pubmed PY - 2009/8/25/medline PY - 2008/9/13/entrez SP - R114 EP - R114 JF - Critical care (London, England) JO - Crit Care VL - 12 IS - 5 N2 - INTRODUCTION: The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP. METHODS: We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers. ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI. ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients. RESULTS: Measurement of ONSD was possible in 95% of cases. The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 6.31 +/- 0.50 mm, 19 measures) than in those with ICP of 20 mmHg or less (5.29 +/- 0.48 mm, 26 measures; P < 0.0001) or in healthy volunteers (5.08 +/- 0.52 mm; P < 0.0001). There was a significant relationship between ONSD and ICP (r = 0.71, P < 0.0001). Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 0.94), with a best cut-off of 5.82 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 5.30 mm. CONCLUSIONS: When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/18786243/Use_of_T2_weighted_magnetic_resonance_imaging_of_the_optic_nerve_sheath_to_detect_raised_intracranial_pressure_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc7006 DB - PRIME DP - Unbound Medicine ER -