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Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement.
BMC Neurol 2017; 17(1):188BN

Abstract

BACKGROUND

Ultrasonograpic retrobulbar optic nerve sheath diameter (ONSD) measurement is considered to be an alternative noninvasive method to estimate intracranial pressure,but the further validation is urgently needed. The aim of the current study was to investigate the association of the ultrasonographic ONSD and intracranial pressure (ICP) in patients.

METHODS

One hundred and ten patients whose intracranial pressure measured via lumbar puncture were enrolled in the study. Their retrobulbar ONSD with B-scan ultrasound was determined just before lumber puncture. The correlation between the ICP and the body mass index (BMI), ONSD or age was established respectively with the Pearson correlation coefficient analysis. The discriminant analysis was used to obtain a discriminant formula for predicting ICP with the ONSD、BMI、gender and age. Another 20 patients were recruited for further validation the efficiency of this discriminant equation.

RESULTS

The mean ICP was 215.3 ± 81.2 mmH2O. ONSD was 5.70 ± 0.80 mm in the right eye and 5.80 ± 0.77 mm in the left eye. A significant correlation was found between ICP and BMI (r = 0.554, p < 0.001), the mean ONSD (r = 0.61, P < 0.001), but not with age (r = -0.131, p = 0.174) and gender (r = 0.03, p = 0.753). Using receiver operating characteristic (ROC) curve analysis, the critical value for the risk mean-ONSD was 5.6 mm from the ROC curve, with the sensitivity of 86.2% and specificity of 73.1%. With 200 mmH2O as the cutoff point for a high or low ICP, stepwise discriminant was applied, the sensitivity and specificity of ONSD predicting ICP was 84.5%-85.7% and 86.5%-92.3%.

CONCLUSIONS

Ophthalmic ultrasound measurement of ONSD may be a good surrogate of invasive ICP measurement. This non-invasive method may be an alternative approach to predict the ICP value of patients whose ICP measurement via lumbar puncture are in high risk. The discriminant formula, which incorporated the factor of BMI, had similar sensitivity and higher specificity than the ROC curve.

Authors+Show Affiliations

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment; Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, 100730, China. Department of Ophthalmology,Xuanwu Hospital, Capital Medical University, Beijing, China.Department of Ophthalmology,Xuanwu Hospital, Capital Medical University, Beijing, China.Department of Ophthalmology,Xuanwu Hospital, Capital Medical University, Beijing, China.Department of Ophthalmology,Xuanwu Hospital, Capital Medical University, Beijing, China.Department of Neurology,Xuanwu Hospital, Capital Medical University, Beijing, China.Beijing Geriatric Healthcare Center, Beijing, China.Beijing Institute of Ophthalmology, Beijing, China.Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, and Chelsea and Westminster Hospital, London, UK.Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment; Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, 100730, China. weiwenbintr@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28962603

Citation

Liu, Dachuan, et al. "Assessment of Intracranial Pressure With Ultrasonographic Retrobulbar Optic Nerve Sheath Diameter Measurement." BMC Neurology, vol. 17, no. 1, 2017, p. 188.
Liu D, Li Z, Zhang X, et al. Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement. BMC Neurol. 2017;17(1):188.
Liu, D., Li, Z., Zhang, X., Zhao, L., Jia, J., Sun, F., ... Wei, W. (2017). Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement. BMC Neurology, 17(1), p. 188. doi:10.1186/s12883-017-0964-5.
Liu D, et al. Assessment of Intracranial Pressure With Ultrasonographic Retrobulbar Optic Nerve Sheath Diameter Measurement. BMC Neurol. 2017 Sep 29;17(1):188. PubMed PMID: 28962603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement. AU - Liu,Dachuan, AU - Li,Zhen, AU - Zhang,Xuxiang, AU - Zhao,Liping, AU - Jia,Jianping, AU - Sun,Fei, AU - Wang,Yaxing, AU - Ma,Daqing, AU - Wei,Wenbin, Y1 - 2017/09/29/ PY - 2017/05/22/received PY - 2017/09/11/accepted PY - 2017/10/1/entrez PY - 2017/10/1/pubmed PY - 2018/3/27/medline KW - B-scan ultrasonography KW - Intracranial pressure KW - Optic nerve sheath diameter SP - 188 EP - 188 JF - BMC neurology JO - BMC Neurol VL - 17 IS - 1 N2 - BACKGROUND: Ultrasonograpic retrobulbar optic nerve sheath diameter (ONSD) measurement is considered to be an alternative noninvasive method to estimate intracranial pressure,but the further validation is urgently needed. The aim of the current study was to investigate the association of the ultrasonographic ONSD and intracranial pressure (ICP) in patients. METHODS: One hundred and ten patients whose intracranial pressure measured via lumbar puncture were enrolled in the study. Their retrobulbar ONSD with B-scan ultrasound was determined just before lumber puncture. The correlation between the ICP and the body mass index (BMI), ONSD or age was established respectively with the Pearson correlation coefficient analysis. The discriminant analysis was used to obtain a discriminant formula for predicting ICP with the ONSD、BMI、gender and age. Another 20 patients were recruited for further validation the efficiency of this discriminant equation. RESULTS: The mean ICP was 215.3 ± 81.2 mmH2O. ONSD was 5.70 ± 0.80 mm in the right eye and 5.80 ± 0.77 mm in the left eye. A significant correlation was found between ICP and BMI (r = 0.554, p < 0.001), the mean ONSD (r = 0.61, P < 0.001), but not with age (r = -0.131, p = 0.174) and gender (r = 0.03, p = 0.753). Using receiver operating characteristic (ROC) curve analysis, the critical value for the risk mean-ONSD was 5.6 mm from the ROC curve, with the sensitivity of 86.2% and specificity of 73.1%. With 200 mmH2O as the cutoff point for a high or low ICP, stepwise discriminant was applied, the sensitivity and specificity of ONSD predicting ICP was 84.5%-85.7% and 86.5%-92.3%. CONCLUSIONS: Ophthalmic ultrasound measurement of ONSD may be a good surrogate of invasive ICP measurement. This non-invasive method may be an alternative approach to predict the ICP value of patients whose ICP measurement via lumbar puncture are in high risk. The discriminant formula, which incorporated the factor of BMI, had similar sensitivity and higher specificity than the ROC curve. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/28962603/Assessment_of_intracranial_pressure_with_ultrasonographic_retrobulbar_optic_nerve_sheath_diameter_measurement_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0964-5 DB - PRIME DP - Unbound Medicine ER -