Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Department of Ophthalmology (P.S.), Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy.
Am J Ophthalmol. 2019 Dec;208:421-428. doi: 10.1016/j.ajo.2019.07.014. Epub 2019 Aug 1.
First, to create an optic nerve growth curve from normal optic nerve sheath diameter (ONSD) values measured by using B-scan ultrasonography in subjects 0-18 years of age. Second, to identify age-appropriate cutoff values of ONSD to be used in the diagnosis of intracranial hypertension (IHT).
Prospective cross-sectional study.
B-scan ocular ultrasonography was performed on both eyes of 215 subjects 0-18 years of age, divided into 3 groups: 165 healthy children, 29 children with IHT (all >4 years of age), and 21 children with optic disc drusen (ODD).
There were no statistically significant differences in between the ONSDs of healthy children and those in subjects with ODD. An optic nerve growth curve was created by using ONSDs measured in healthy subjects 0-18 years of age, using the equation: ONSD = ln [33.15] - (-0.18 × ln [children's age]). The curve showed a progressive increase of ONSD up to 10 years of age, and it remained constant until the age of 18. For this reason, 2 different cutoff values were calculated for age groups 4-10 and 11-18. Values were 4.10 mm and 4.4 mm, respectively, with a 100.0% sensitivity and a specificity ranging from 83.9% to 98.8%. A sensitivity of 28.6% was reached for the population of subjects 4-18 years of age with a threshold value of 5 mm, as used in published reports.
The ONSD continued to enlarge gradually until the age of 10. Therefore, 2 different cutoff values for the age groups 4-10 and 11-18 were calculated, considering the ONSDs of subjects 11-18 years of age overlapping with those of adults. No patients with IHT <4 years old were found. Further studies are needed to evaluate the correct cutoff values for these ages.
首先，通过对 0-18 岁人群的视神经鞘直径（ONSD）值进行 B 型超声扫描，建立视神经生长曲线。其次，确定适合各年龄段的 ONSD 截断值，用于诊断颅内高压（IHT）。
前瞻性横断面研究。
对 215 例 0-18 岁人群的双眼进行 B 型超声眼部检查，分为 3 组：165 例健康儿童、29 例 IHT 患儿（均>4 岁）和 21 例视盘玻璃疣（ODD）患儿。
健康儿童与 ODD 患儿的 ONSD 无统计学差异。使用健康受试者 0-18 岁的 ONSD 值建立视神经生长曲线，公式为：ONSD=ln[33.15]-(-0.18×ln[儿童年龄])。该曲线显示 ONSD 随年龄增长呈逐渐增加趋势，直至 10 岁，18 岁后保持不变。因此，为 4-10 岁和 11-18 岁年龄组分别计算了 2 个不同的截断值，分别为 4.10mm 和 4.4mm，灵敏度均为 100.0%，特异性为 83.9%-98.8%。使用文献报道的 5mm 阈值，4-18 岁人群的敏感性为 28.6%。
ONSD 持续逐渐增大，直至 10 岁。因此，考虑到 11-18 岁受试者的 ONSD 与成人重叠，为 4-10 岁和 11-18 岁年龄组分别计算了 2 个不同的截断值。未发现<4 岁的 IHT 患者。需要进一步研究来评估这些年龄段的正确截断值。
