超声和光学相干断层扫描在儿童视乳头水肿与假性视乳头水肿鉴别诊断中的应用。

Utility of Ultrasound and Optical Coherence Tomography in Differentiating Between Papilledema and Pseudopapilledema in Children.

机构信息

Division of Ophthalmology (MKF), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Departments of Neurology (GTL, RAA), and Ophthalmology (MKF, G-SY, RAA), The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

J Neuroophthalmol. 2021 Dec 1;41(4):488-495. doi: 10.1097/WNO.0000000000001248.

DOI:10.1097/WNO.0000000000001248

PMID:33870950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8514567/

Abstract

BACKGROUND

Differentiating between papilledema and pseudopapilledema in children presenting with mild-to-moderate optic nerve head elevation is challenging. This study sought to determine which B-scan ultrasonography (BSUS) and optical coherence tomography (OCT) features, individually or in combination, are best able to differentiate between papilledema and pseudopapilledema in children.

METHODS

Children presenting with optic nerve head elevation of unknown etiology were eligible if they underwent BSUS and OCT performed by the same investigator. The absolute optic nerve sheath diameter (in millimeter) along with the presence/absence of a hyperreflective nodule(s) at the optic nerve head (indicative of druse) from BSUS was determined. The average circumpapillary retinal nerve fiber layer (cpRNFL), diameter of Bruch membrane opening, maximum papillary height, and the presence/absence of hyper-/hyporeflective lesions at the optic nerve head were calculated. Sensitivity and specificity were calculated to evaluate which BSUS and OCT imaging features, individually and in combination, accurately classified children as having papilledema vs pseudopapilledema.

RESULTS

One hundred eighty-one eyes from 94 children (mean age, 11.0 years; range, 3.2-17.9) were included; 36 eyes with papilledema and 145 eyes with pseudopapilledema. Among BSUS features, optic nerve sheath widening (>4.5 mm) demonstrated the best sensitivity (86%; 95% confidence interval [CI], 64%-96%) and specificity (88%; 95% CI, 79%-94%) for papilledema. Among OCT measures, cpRNFL thickness of ≥140 µm demonstrated the best sensitivity (83%; 95% CI, 66%-93%) and specificity (76%; 95% CI, 66%-84%) to identify papilledema. The presence of both optic nerve sheath widening (>4.5 mm) and cpRNFL thickness of ≥140 µm reduced the sensitivity (72%; 95% CI, 52%-86%) but increased specificity (95%; 95% CI, 88%-98%).

CONCLUSION

BSUS (optic nerve sheath widening [>4.5 mm]) and OCT (cpRNFL thickness ≥140 µm), individually and collectively, have good diagnostic accuracy for differentiating between papilledema and pseudopapilledema. The presence of druse does not exclude the diagnosis of papilledema.

摘要

背景

在出现轻度至中度视神经头抬高的儿童中，区分视乳头水肿和假性视乳头水肿具有挑战性。本研究旨在确定哪些 B 型超声扫描（BSUS）和光学相干断层扫描（OCT）特征，无论是单独使用还是组合使用，能够最好地区分儿童中的视乳头水肿和假性视乳头水肿。

方法

如果接受相同研究者进行的 BSUS 和 OCT 检查，则符合条件的是出现视神经头抬高的病因不明的儿童。确定 BSUS 中视神经鞘直径（毫米）的绝对值以及视神经头处是否存在（不存在）高反射性结节（表示结石）。计算平均环周视网膜神经纤维层（cpRNFL）、Bruch 膜开口直径、最大视乳头高度以及视神经头处是否存在高反射/低反射病变。计算敏感性和特异性，以评估 BSUS 和 OCT 成像特征，单独和组合使用，是否能够准确地将儿童分类为视乳头水肿与假性视乳头水肿。

结果

纳入了 94 名儿童的 181 只眼（平均年龄 11.0 岁；范围 3.2-17.9 岁）；36 只眼为视乳头水肿，145 只眼为假性视乳头水肿。在 BSUS 特征中，视神经鞘增宽（>4.5 毫米）对视乳头水肿的敏感性（86%；95%置信区间[CI]，64%-96%）和特异性（88%；95% CI，79%-94%）最佳。在 OCT 测量中，cpRNFL 厚度≥140 µm 对视乳头水肿的敏感性（83%；95% CI，66%-93%）和特异性（76%；95% CI，66%-84%）最佳。同时存在视神经鞘增宽（>4.5 毫米）和 cpRNFL 厚度≥140 µm 降低了敏感性（72%；95% CI，52%-86%），但提高了特异性（95%；95% CI，88%-98%）。