From the Lisbon School of Medicine-Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal (D.B., A.P.A., L.A.P., J.T.F., L.L.N.); Department of Neurological Imaging, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal (D.B., I.C., L.L.N.); Católica Medical School, Lisbon, Portugal (D.B., I.F.); Department of Neurology, Unidade de Neurociências, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (A.P.A.); Centro de Estudos Egaz Moniz, Universidade de Lisboa, Lisbon, Portugal (A.P.A.); Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal (L.A.P., J.T.F.); Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal (I.F.); and NOVA Medical School-Faculdade de Ciências Médicas, Lisbon, Portugal (I.F.).
Radiology. 2024 Jul;312(1):e240114. doi: 10.1148/radiol.240114.
Background Discrepancies in the literature regarding optimal optic nerve sheath diameter (ONSD) cutoffs for intracranial pressure (ICP) necessitate alternative neuroimaging parameters to improve clinical management. Purpose To evaluate the diagnostic accuracy of the dimensions of the perineural subarachnoid space to the optic nerve sheath ratio, measured using US, in predicting increased ICP. Materials and Methods In a prospective cohort study from April 2022 to December 2023, patients with suspected increased ICP underwent optic nerve US to determine the dimensions of arachnoid bulk (DAB) ratio and ONSD before invasive ICP measurement. Correlation between the parameters and ICP, as well as diagnostic accuracy, was assessed using area under the receiver operating characteristic curve (AUC) analysis. Results A total of 30 participants were included (mean age, 39 years ± 14 [SD]; 24 female). The DAB ratio and ONSD were significantly larger in participants with increased ICP (38% [0.16 of 0.42] and 14% [0.82 of 6.04 mm], respectively; < .001). The DAB ratio showed a stronger correlation with ICP than ONSD ( = 0.87 [ < .001] vs = 0.61 [ < .001]). The DAB ratio and ONSD optimal cutoffs for increased ICP were 0.5 and 6.5 mm, respectively, and the ratio had higher sensitivity (100% vs 92%) and specificity (94% vs 83%) compared with ONSD. Moreover, the DAB ratio better predicted increased ICP than ONSD, with a higher AUC (0.98 [95% CI: 0.95, 1.00] vs 0.86 [95% CI: 0.71, 0.95], = .047). Conclusion An imaging ratio was proposed to predict ICP based on the relative anatomy of the cerebrospinal fluid space, demonstrating more accurate diagnosis of increased ICP and a strong correlation with ICP values, suggesting its potential utility as a neuroimaging marker in clinical settings. © RSNA, 2024 See also the editorial by Shepherd in this issue.
背景 文献中关于视神经鞘直径（ONSD）用于颅内压（ICP）的最佳截断值存在差异，因此需要替代神经影像学参数来改善临床管理。目的 评估使用超声测量的视神经鞘周围神经鞘下腔与视神经鞘比率的维度（perineural subarachnoid space to the optic nerve sheath ratio，PSD-ONSDR）对预测 ICP 升高的诊断准确性。材料与方法 在 2022 年 4 月至 2023 年 12 月的前瞻性队列研究中，疑似 ICP 升高的患者接受视神经超声检查，以确定蛛网膜膨出幅度（DAB）比率和 ONSD，然后进行有创 ICP 测量。使用受试者工作特征曲线（receiver operating characteristic curve，ROC）下面积（area under the receiver operating characteristic curve，AUC）分析评估参数与 ICP 的相关性和诊断准确性。结果 共纳入 30 名参与者（平均年龄，39 岁±14[标准差]；24 名女性）。ICP 升高的患者的 DAB 比率和 ONSD 显著增大（分别为 38%[0.16 比 0.42]和 14%[0.82 比 6.04mm]；<.001）。DAB 比率与 ICP 的相关性强于 ONSD（ = 0.87[<.001]比 = 0.61[<.001]）。DAB 比率和 ONSD 用于预测 ICP 升高的最佳截断值分别为 0.5 和 6.5mm，DAB 比率的敏感性（100%比 92%）和特异性（94%比 83%）均高于 ONSD。此外，DAB 比率比 ONSD 更能准确预测 ICP 升高，AUC 更高（0.98[95%CI：0.95，1.00]比 0.86[95%CI：0.71，0.95]； =.047）。结论 提出了一种基于脑积液空间相对解剖的成像比值，用于预测 ICP，对 ICP 升高的诊断更准确，与 ICP 值相关性更强，提示其在临床环境中作为神经影像学标志物的潜在应用价值。©RSNA，2024 参见本期 Shepherd 的社论。
