Das Sudha Kiran, Shetty Sachin P, Sen Kamal Kumar
Department of Radiodiagnosis and Imaging, JSS Medical College and Hospital (JSS University), Mysore, Karnataka, India.
Pol J Radiol. 2017 Apr 28;82:240-243. doi: 10.12659/PJR.900196. eCollection 2017.
Optic nerve sheath diameter (ONSD) evaluated in CT imaging as well as Rotterdam CT Score (RCTS) are proven independent predictors of outcome in patients with traumatic brain injury (TBI). To date, no study has correlated ONSD on admission CT scan with RCTS.
MATERIAL/METHODS: Retrospective cohort study comprised of consecutive patients undergoing CT imaging for traumatic brain injury recruited between January and October 2015. Bilateral ONSD was measured 3 mm behind the eyeball in axial and sagittal planes and mean value was calculated. RCTS was assessed on the same CT images, bias was eliminated by blinding RCTS to ONSD measurement.
150 patients were included; mean age in the group was 42.94±16.7 years. ONSD in mild TBI, RCTS 2 and 3 were 3.3 mm (SD 0.39 mm) and 4.1 mm (0.047 mm), respectively. Mean ONSD in moderate and severe TBI (RCTS score 4 and above) was 4.83 mm and above, SD 0.4 mm. Mean ONSD correlated with occurrence of diffuse cerebral oedema, presence of subdural and extradural hematoma; however in isolation there was no statistical significance.
Higher ONSD was observed in patients with moderate and severe TBI, correlating with admission RCTS of 4 and above. Subsequent increase in ONSD was also found with increase in RCTS. ONSD could serve as an initial triage tool in the emergency department as well as a method of determining the need for sequential CT in patients with mild TBI.
在CT成像中评估的视神经鞘直径（ONSD）以及鹿特丹CT评分（RCTS）已被证明是创伤性脑损伤（TBI）患者预后的独立预测指标。迄今为止，尚无研究将入院CT扫描时的ONSD与RCTS进行相关性分析。
材料/方法：回顾性队列研究，纳入了2015年1月至10月间因创伤性脑损伤接受CT成像的连续患者。在轴位和矢状位平面上，于眼球后方3mm处测量双侧ONSD，并计算平均值。在相同的CT图像上评估RCTS，通过对RCTS测量结果进行盲法处理来消除偏差。
共纳入150例患者；该组患者的平均年龄为42.94±16.7岁。轻度TBI、RCTS 2级和3级患者的ONSD分别为3.3mm（标准差0.39mm）和4.1mm（0.047mm）。中度和重度TBI（RCTS评分4分及以上）患者的平均ONSD为4.83mm及以上，标准差0.4mm。平均ONSD与弥漫性脑水肿的发生、硬膜下和硬膜外血肿的存在相关；然而，单独来看并无统计学意义。
中度和重度TBI患者的ONSD较高，与入院RCTS 4分及以上相关。随着RCTS的增加，还发现ONSD随后也会增加。ONSD可作为急诊科的初始分诊工具，以及确定轻度TBI患者是否需要进行后续CT检查的一种方法。
