Stroke Unit, City of Health and Science University Hospital of Turin, Turin, Italy.
Cancer Epidemiology Unit and CPO Unit, and Division of Emergency Medicine and High Dependency Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
J Neuroimaging. 2019 May;29(3):394-399. doi: 10.1111/jon.12604. Epub 2019 Feb 3.
Evaluation of the diagnostic accuracy of optic nerve sheath diameter (ONSD) and Doppler indices of central retinal arteries and veins for the detection of increased intracranial pressure (ICP) in intracerebral hemorrhage (ICH) and of the usefulness of a second assessment of these variables in the monitoring of ICH.
A total of 46 acute ICH patients with (group 1, n = 25) and without (group 2, n = 21) clinical and radiological computed tomography signs of raised ICP and 40 healthy controls were recruited. The median binocular ONSD and Doppler indices of retinal vessels including resistive index (RI) and retinal venous pulsation (RVP) were compared among groups, both at admission and later during ICH monitoring.
Median binocular ONSD showed higher accuracy for the detection of increased ICP (sensitivity and specificity 100%), while Doppler indices were less accurate (sensitivity 48% and specificity 95% for RI; 80% and 62% for RVP). In ICH patients, ONSD was significantly elevated in group 1 both at admission (6.40 mm [interquartile range [IQR] = .70] vs. 4.70 [.40]) and at control time (6.00 [.55] vs. 4.55 [.40]; P < .01), as well as RI (.79 [.11] vs. .77 [.03] and .80 [.06] vs. .75 [.35]; P = .01). RVP was significantly increased in group 1 only at admission (3.20 cm/s [1.05] vs. 2.00 [1.55], P = .02).
Median binocular ONSD evaluation showed higher accuracy for the estimation of elevated ICP compared with Doppler indices of retinal vessels. The ONSD enlargement detected in the early phase of ICH persists at control time.
评估视神经鞘直径（ONSD）和中央视网膜动静脉多普勒指数对颅内出血（ICH）患者颅内压升高（ICP）的诊断准确性，以及对这些变量的二次评估在 ICH 监测中的有用性。
共纳入 46 例急性 ICH 患者（有临床和影像学 CT 征象组 1，n = 25；无临床和影像学 CT 征象组 2，n = 21）和 40 例健康对照者。比较各组入院时和 ICH 监测期间的双眼 ONSD 中位数和视网膜血管多普勒指数（包括阻力指数（RI）和视网膜静脉搏动（RVP））。
双眼 ONSD 对 ICP 升高的检测具有较高的准确性（敏感性和特异性均为 100%），而多普勒指数的准确性较低（RI 的敏感性为 48%，特异性为 95%；RVP 的敏感性为 80%，特异性为 62%）。在 ICH 患者中，组 1 患者的 ONSD 在入院时（6.40mm[四分位距（IQR）：0.70]vs.4.70mm[0.40]）和对照时间（6.00mm[0.55]vs.4.55mm[0.40]）均显著升高（P<.01），RI 也显著升高（.79[0.11]vs.0.77[0.03]和.80[0.06]vs.0.75[0.35]；P=.01）。RVP 仅在入院时显著升高（3.20cm/s[1.05]vs.2.00cm/s[1.55]；P=.02）。
与视网膜血管多普勒指数相比，双眼 ONSD 评估对估计 ICP 升高具有更高的准确性。ICH 早期发现的 ONSD 增大在对照时间持续存在。
