Lee Han-Bin, Oh Sang Hoon, Jang Jinhee, Koo Jaseong, Bang Hyo Jin, Lee Min Hwan
Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Diagnostics (Basel). 2024 Aug 12;14(16):1754. doi: 10.3390/diagnostics14161754.
The optic nerve sheath diameter (ONSD) can predict intracranial pressure and outcomes in neurological disease, but it remains unclear whether a small ONSD can be accurately measured on routine CT images with a slice thickness of approximately 4-5 mm. We measured the ONSD and ONSD/eyeball transverse diameter (ETD) ratio on routine-slice (4 mm) and thin-slice (0.6-0.75 mm) brain CT images from initial scans of acute ischemic stroke (AIS) patients. ONSD-related variables, National Institutes of Health Stroke Scale (NIHSS) scores, and age were compared between good (modified Rankin Scale [mRS] ≤ 2) and poor (mRS > 2) outcomes at discharge. Among 155 patients, 38 had poor outcomes. The thin-slice ONSD was different between outcome groups ( = 0.047), while the routine-slice ONSD showed no difference. The area under the curve (AUC) values for the ONSD and ONSD/ETD were 0.58 (95% CI, 0.49-0.66) and 0.58 (95% CI, 0.50-0.66) on the routine-slice CT, and 0.60 (95% CI, 0.52-0.68) and 0.62 (95% CI, 0.54-0.69) on the thin-slice CT. The thin-slice ONSD/ETD ratio correlated with initial NIHSS scores (r = 0.225, = 0.005). After adjusting for NIHSS scores and age, ONSD-related variables were not associated with outcomes, and adding them to a model with NIHSS scores and age did not improve performance (all -values > 0.05). Although ONSD measurements were not an independent outcome predictor, they correlated with stroke severity, and the thin-slice ONSD provided a slightly better prognostic performance than the routine-slice ONSD.
视神经鞘直径（ONSD）可预测神经系统疾病的颅内压及预后，但尚不清楚在层厚约4 - 5毫米的常规CT图像上能否准确测量较小的ONSD。我们在急性缺血性卒中（AIS）患者初次扫描的常规层厚（4毫米）和薄层厚（0.6 - 0.75毫米）脑部CT图像上测量了ONSD及ONSD/眼球横径（ETD）比值。比较了出院时预后良好（改良Rankin量表[mRS]≤2）和预后不良（mRS>2）患者的ONSD相关变量、美国国立卫生研究院卒中量表（NIHSS）评分及年龄。155例患者中，38例预后不良。预后组间薄层厚ONSD存在差异（ = 0.047），而常规层厚ONSD无差异。常规层厚CT上ONSD及ONSD/ETD的曲线下面积（AUC）值分别为0.58（95%CI，0.49 - 0.66）和0.58（95%CI，0.50 - 0.66），薄层厚CT上分别为0.60（95%CI，0.52 - 0.68）和0.62（95%CI，0.54 - 0.69）。薄层厚ONSD/ETD比值与初始NIHSS评分相关（r = 0.225， = 0.005）。校正NIHSS评分和年龄后，ONSD相关变量与预后无关，将其加入NIHSS评分和年龄模型中并未改善预测性能（所有 -值>0.05）。虽然ONSD测量不是独立的预后预测指标，但它们与卒中严重程度相关，且薄层厚ONSD的预后性能略优于常规层厚ONSD。
