Lin Sophia D, Kahne Kimberly R, El Sherif Amira, Mennitt Kevin, Kessler David, Ward Mary J, Platt Shari L
Departments of Pediatrics and.
Radiology, Weill Cornell Medical College, New York, NY.
Pediatr Emerg Care. 2019 Apr;35(4):268-272. doi: 10.1097/PEC.0000000000001034.
The goal of this study was to assess the accuracy of ultrasound-measured optic nerve sheath diameter (ONSD) as a screen for ventriculoperitoneal shunt failure.
We prospectively enrolled a convenience sample of children presenting to the ED with suspected shunt failure. The ONSD was measured by ultrasound and compared with computed tomography/magnetic resonance imaging (CT/MRI) and neurosurgical impression. We defined shunt failure on ultrasound as an ONSD greater than 4.0 mm in infants 12 months and younger or greater than 4.5 mm in children older than 12 months. A single emergency radiologist at our institution read all CTs and MRIs for categorical determination of shunt failure. We defined shunt failure based on neurosurgical impression as a decision to admit and perform shunt revision. We report test characteristics and 95% confidence intervals of ONSD as a predictor for shunt failure.
We enrolled 32 subjects. The sensitivities of ONSD compared with CT/MRI and neurosurgical impression, 60.0% and 75.0%, respectively, were low. However, the negative predictive values of ONSD compared with CT/MRI and neurosurgical impression were 90.0% and 95.0%, respectively.
Optic nerve sonography may be a useful tool to identify children presenting with suspected ventriculoperitoneal shunt failure who do not require further imaging. This would reduce the use of CT scan and exposure to ionizing radiation in children with suspected shunt malfunction who do not require neurosurgical intervention. Consideration of additional risk factors and a larger sample size may yield stronger results.
本研究的目的是评估超声测量视神经鞘直径（ONSD）作为脑室腹腔分流术失败筛查指标的准确性。
我们前瞻性地纳入了因疑似分流术失败而到急诊科就诊的儿童便利样本。通过超声测量ONSD，并与计算机断层扫描/磁共振成像（CT/MRI）及神经外科诊断结果进行比较。我们将超声检查时ONSD大于4.0毫米定义为12个月及以下婴儿分流术失败，大于4.5毫米定义为12个月以上儿童分流术失败。我们机构的一名急诊放射科医生解读所有CT和MRI，以明确分流术失败的分类。我们将基于神经外科诊断结果决定入院并进行分流术修复定义为分流术失败。我们报告了ONSD作为分流术失败预测指标的检测特征及95%置信区间。
我们纳入了32名受试者。与CT/MRI及神经外科诊断结果相比，ONSD的敏感度分别为60.0%和75.0%，较低。然而，与CT/MRI及神经外科诊断结果相比，ONSD的阴性预测值分别为90.0%和95.0%。
视神经超声检查可能是一种有用的工具，可用于识别疑似脑室腹腔分流术失败但无需进一步影像学检查的儿童。这将减少对疑似分流术故障但无需神经外科干预的儿童进行CT扫描及电离辐射暴露。考虑其他风险因素及更大样本量可能会得出更强有力的结果。
