Xu Nan, Zhu Qiang
Department of Ultrasonography, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Med Ultrason. 2023 Sep 29;25(3):270-278. doi: 10.11152/mu-4037. Epub 2023 Jun 22.
To compare the accuracy of the optic nerve sheath diameter (ONSD) measured by ocular ultrasonography (US) versus magnetic resonance imaging (MRI) for the diagnosis of increased intracranial pressure (ICP).
A systematic search of studies evaluating US ONSD or MRI ONSD for the diagnosis of increased ICP was performed. Data were extracted independently by two authors. We used the bivariate random-effects model to evaluate the diagnostic feasibility of measuring the ONSD in patients increased ICP. A summary receiver operating characteristic (SROC) graph was adopted to calculate sensitivity and specificity. Subgroup analysis was used to explore potential difference in US ONSD and MRI ONSD.
A total of 31 studies were included, in which there were 1783 patients diagnosed with US ONSD and 730 patients diagnosed with MRI ONSD. Twenty studies reporting US ONSD were included for quantitative synthesis. The US ONSD had a high diagnostic accuracy, involving estimated sensitivity of 0.92 (95%CI 0.87-0.95), estimated specificity of 0.85 (95%CI 0.79-0.89), positive likelihood ratio (PLR) of 6.0 (95%CI 4.3-8.4), negative likelihood ratio (NLR) of 0.10 (95%CI 0.06-0.15) and Diagnostic Odds Ratio (DOR) of 62 (95%CI 33-117). The data of 11 studies adopting MRI ONSD was pooled. The MRI ONSD demonstrated estimated sensitivity of 0.70 (95%CI 0.60-0.78), estimated specificity of 0.85 (95%CI 0.80-0.90), PLR of 4.8 (95%CI 3.4-6.7), NLR of 0.35 (95%CI 0.27-0.47) and DOR of 13 (95%CI 8-22). The subgroup analysis showed that US ONSD demonstrated a higher sensitivity (0.92 versus 0.70; p<0.01) and almost equal specificity (0.85 vs. 0.85; p=0.67) compared with MRI ONSD.
Measurement of ONSD can be a useful tool to predict raised ICP. The US ONSD demonstrated better accuracy than MRI ONSD for the diagnosis of increased ICP.
比较眼部超声（US）与磁共振成像（MRI）测量视神经鞘直径（ONSD）用于诊断颅内压升高（ICP）的准确性。
系统检索评估US测量ONSD或MRI测量ONSD用于诊断ICP升高的研究。由两位作者独立提取数据。我们使用双变量随机效应模型评估测量ONSD对ICP升高患者的诊断可行性。采用汇总受试者工作特征（SROC）图计算敏感性和特异性。进行亚组分析以探索US测量ONSD和MRI测量ONSD之间的潜在差异。
共纳入31项研究，其中1783例患者采用US测量ONSD进行诊断，730例患者采用MRI测量ONSD进行诊断。纳入20项报告US测量ONSD的研究进行定量综合分析。US测量ONSD具有较高的诊断准确性，估计敏感性为0.92（95%CI 0.87 - 0.95），估计特异性为0.85（95%CI 0.79 - 0.89），阳性似然比（PLR）为6.0（95%CI 4.3 - 8.4），阴性似然比（NLR）为0.10（95%CI 0.06 - 0.15），诊断比值比（DOR）为62（95%CI 33 - 117）。汇总11项采用MRI测量ONSD的研究数据。MRI测量ONSD的估计敏感性为0.70（95%CI 0.60 - 0.78），估计特异性为0.85（95%CI 0.80 - 0.90），PLR为4.8（95%CI 3.4 - 6.7），NLR为0.35（95%CI 0.27 - 0.47），DOR为13（95%CI 8 - 22）。亚组分析显示，与MRI测量ONSD相比，US测量ONSD具有更高的敏感性（0.92对0.70；p<0.01）和几乎相同的特异性（0.85对0.85；p = 0.67）。
测量ONSD可作为预测ICP升高的有用工具。在诊断ICP升高方面，US测量ONSD比MRI测量ONSD具有更高的准确性。
