Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Eur J Radiol. 2020 Apr;125:108875. doi: 10.1016/j.ejrad.2020.108875. Epub 2020 Feb 8.
To evaluate the correlation between optic nerve sheath diameter (ONSD) measurement with signs of increased intracranial pressure (ICP) found on computed tomography (CT) in trauma patients.
271 consecutive head CT trauma scans performed at our trauma center were retrospectively reviewed for ONSD and CT findings. Measurement of ONSD was made at CT and, when available, with ultrasonography (US). Imaging signs of increased ICP were assessed. Association between ONSD and signs of ICP were analyzed.
The mean ONSD on axial CT images, optic-nerve axial plane and US was 4.70 ± 0.59 mm, 4.78 ± 0.59 mm, and 3.16 ± 0.50 mm, respectively. The ONSD measured at CT was significantly higher than that measured by US(p < 0.01). No difference of ONSD measured at CT between axial and optic-nerve axial planes. Patients with CT evidence of increased ICP had significantly higher ONSD than those without imaging abnormalities (p = 0.0001-0.0064). The ONSD cutoff points for suggesting increased ICP were 4.8 mm (60.5 % sensitivity, 61.2 % specificity, 20.4 % PPV, 90.4 % NPV) at CT and 3.15 mm (97.4 % sensitivity, 13.8 % specificity, 15.7 % PPV, 97 % NPV) at US.
There was a significant association between ONSD and imaging signs of increased ICP in CT with a high NPV. No difference of ONSD measurement at CT between normal and optic-nerve axial planes was observed, whereas there was a significant difference between diameter obtained at CT and US.
评估创伤患者视神经鞘直径（ONSD）测量值与计算机断层扫描（CT）上发现的颅内压升高（ICP）征象之间的相关性。
回顾性分析我院创伤中心 271 例连续头部 CT 外伤扫描，测量 ONSD 并评估 CT 表现。在 CT 上测量 ONSD，并在有条件时进行超声（US）测量。评估 ICP 升高的影像学征象。分析 ONSD 与 ICP 征象之间的关系。
轴向 CT 图像、视神经轴位平面和 US 上的平均 ONSD 分别为 4.70±0.59mm、4.78±0.59mm 和 3.16±0.50mm。CT 测量的 ONSD 明显高于 US 测量的 ONSD（p<0.01）。CT 轴位与视神经轴位平面上的 ONSD 无差异。CT 提示 ICP 升高的患者 ONSD 明显高于无影像学异常的患者（p=0.0001-0.0064）。提示 ICP 升高的 ONSD 截断点为 CT 上 4.8mm（60.5%敏感性、61.2%特异性、20.4%PPV、90.4%NPV）和 US 上 3.15mm（97.4%敏感性、13.8%特异性、15.7%PPV、97%NPV）。
CT 上 ONSD 与 ICP 升高的影像学征象之间存在显著相关性，具有较高的 NPV。在正常和视神经轴位平面上，CT 测量的 ONSD 无差异，但 CT 和 US 上获得的直径有显著差异。
