Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
J Neurol Sci. 2023 Nov 15;454:120853. doi: 10.1016/j.jns.2023.120853. Epub 2023 Oct 30.
To review the optimal diagnostic cut-off of ultrasonographic optic nerve sheath diameter (ONSD) in the diagnosis of increased intracranial pressure (IICP).
A systematic search was conducted of available studies assessing the use of ONSD ultrasonography in patients with suspected IICP. Meta-analysis of diagnostic accuracy of ultrasonographic ONSD was performed using a bivariate model of random effects to summarize pooled sensitivity and specificity. A summary receiver operating characteristics (SROC) curve was plotted. Accuracy measures associated with ONSD cut-off and predefined covariates were investigated with meta-regression.
We included 38 studies, comprising a total of 2824 patients. A total of 21 studies used invasive techniques as a reference standard estimation of IICP and meta-analysis revealed a pooled sensitivity of 0.90 (95% CI 0.85-0.93) and specificity of 0.87 (95% CI 0.80-0.91). Optimal ONSD cut-off values ranged between 4.1 mm and 7.2 mm. Meta-regression analysis showed that ONSD cut-off values of 5.6 to 6.3 mm were associated with higher pooled specificity compared to cut-off values of 4.9 to 5.5 mm (0.93, 95% CI 0.85-0.97 vs. 0.78, 95% CI 0.65-0.87; p = 0.036).
Ultrasonography of ONSD shows a high diagnostic accuracy for IICP, with high pooled sensitivity and specificity. Additionally, larger cut-off values seem to significantly increase specificity without compromising sensitivity, which support their use as optimal ONSD cut-off. The overall high sensitivity of ultrasonographic ONSD suggests its usefulness as a screening tool for IIC, which may provide an estimate of when invasive methods are warranted.
ONSD ultrasonography is a fast and cost-effective method with a high diagnostic accuracy to detect IICP. The optimum ONSD cut-off hasn't been established before, but we suggest the 5.6 to 6.3 mm range as the best for the diagnosis of IICP.
回顾超声视神经鞘直径（ONSD）在诊断颅内压升高（ICP）中的最佳诊断截断值。
系统检索了评估超声 ONSD 用于疑似 IICP 患者的研究。使用双变量随机效应模型对超声 ONSD 的诊断准确性进行荟萃分析，以总结汇总敏感性和特异性。绘制汇总受试者工作特征（SROC）曲线。使用元回归研究与 ONSD 截断值和预定义协变量相关的准确性度量。
我们纳入了 38 项研究，共包括 2824 名患者。共有 21 项研究使用侵入性技术作为 ICP 的参考标准估计，荟萃分析显示汇总敏感性为 0.90（95%CI 0.85-0.93），特异性为 0.87（95%CI 0.80-0.91）。最佳 ONSD 截断值范围在 4.1-7.2mm 之间。元回归分析显示，5.6-6.3mm 的 ONSD 截断值与 4.9-5.5mm 的截断值相比，具有更高的汇总特异性（0.93，95%CI 0.85-0.97 对 0.78，95%CI 0.65-0.87；p=0.036）。
ONSD 超声检查对 ICP 具有较高的诊断准确性，具有较高的汇总敏感性和特异性。此外，较大的截断值似乎可以在不影响敏感性的情况下显著提高特异性，支持将其作为最佳 ONSD 截断值。超声 ONSD 的总体高敏感性表明其作为 IICP 筛查工具的有用性，这可能提供了一个何时需要侵入性方法的估计。
ONSD 超声检查是一种快速且具有成本效益的方法，具有较高的诊断准确性，可用于检测 ICP。之前尚未确定最佳的 ONSD 截断值，但我们建议将 5.6-6.3mm 范围作为诊断 ICP 的最佳值。
