Fu Zunfeng, Peng Lin, Guo Laicai, Hu Naixia, Zhu Yamin, Tang Shouxin, Lou Hongliang, Zhang Jiajun, Wang Chongqiang
Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
Department of General Practice, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
Front Neurol. 2025 Jan 15;15:1472494. doi: 10.3389/fneur.2024.1472494. eCollection 2024.
Elevated intracranial pressure (ICP), a common complication in traumatic brain injuries (TBI), can lead to optic nerve sheath diameter (ONSD) enlargement and flow spectrum changes from the internal carotid artery (ICA) to middle cerebral artery (MCA). This study will investigate the use of Cervical-Cerebral Arterial Ultrasound (CCAU) for non-invasive ICP assessment and evaluating the related indices' clinical utility in TBI patients with decompressive craniotomy (DC).
ONSD and flow spectrum changes were measured within 24 h after DC in 106 patients via ultrasonic ONSD measurement and CCAU, simultaneously. Intracranial pressures were invasively monitored, using a microsensor or ventricular catheter as the gold standard. Patients were classified into two groups, namely the normal group and the elevated group, based on distinct intracranial pressure thresholds of 15 mmHg, 20 mmHg and 22 mmHg. Subsequently, Bland Altman plot used for evaluating agreement between estimate for ICP (ICPe) and invasive ICP (ICPi). Then, the correlation between ONSD, MCAPI (pulsatility index of MCA), PI-ratio (MCAPI/ICAPI), and ICP was examined through linear regression analysis. Finally, receiver operator characteristic curves (ROC) were also analyzed for different indexes and their combinations (using logistic model).
Significant differences were observed between the normal and elevated ICP groups with respect to ONSD, PI-ratio, MCAPI and MCAFVd (diastolic flow velocity of MCA) ( < 0.05). The correlation coefficients for the relationships between ONSD, PI ratio, FVd, and PI with ICPi were 0.62, 0.33, 0.32 and 0.21, respectively, each demonstrating statistical significance ( < 0.05). Analysis of the ROC curves demonstrated that the area under the curve (AUC) for predicting elevated ICPi at thresholds of 15 mmHg, 20 mmHg, and 22 mmHg via combined ultrasonographic measurements of the PI ratio and ONSD was the largest, specifically 0.74 (95% CI: 0.65-0.82), 0.77 (95% CI: 0.69-0.85), and 0.79 (95% CI: 0.70-0.86), respectively.
Ultrasonographic measurements of ONSD, PI-ratio, MCAPI and MCAFVd demonstrate a moderate to low weak correlation with ICPi measurements. ICPe is not considered sufficiently precise for noninvasive accurate ICP assessment. The concurrent utilization of CCAU and ONSD measurements may offer superior accuracy for elevated ICP in TBI patients with DC, especially in specificity. Further research is imperative to validate these findings within a more extensive patient population.
颅内压（ICP）升高是创伤性脑损伤（TBI）的常见并发症，可导致视神经鞘直径（ONSD）增大以及从颈内动脉（ICA）到大脑中动脉（MCA）的血流频谱变化。本研究将探讨颈脑动脉超声（CCAU）用于无创ICP评估以及评估相关指标在接受减压颅骨切除术（DC）的TBI患者中的临床效用。
对106例患者在DC术后24小时内通过超声ONSD测量和CCAU同时测量ONSD和血流频谱变化。采用微传感器或脑室导管作为金标准进行有创颅内压监测。根据15 mmHg、20 mmHg和22 mmHg的不同颅内压阈值将患者分为两组，即正常组和升高组。随后，使用Bland Altman图评估估计的ICP（ICPe）与有创ICP（ICPi）之间的一致性。然后，通过线性回归分析检查ONSD、MCA搏动指数（MCAPI）、PI比值（MCAPI/ICAPI）与ICP之间的相关性。最后，还对不同指标及其组合（使用逻辑模型）进行了受试者操作特征曲线（ROC）分析。
正常ICP组和升高ICP组在ONSD、PI比值、MCAPI和MCA舒张期血流速度（MCAFVd）方面存在显著差异（<0.05）。ONSD、PI比值、FVd和PI与ICPi之间关系的相关系数分别为0.62、0.33、0.32和0.21，均具有统计学意义（<0.05）。ROC曲线分析表明，通过联合超声测量PI比值和ONSD预测ICPi在15 mmHg、20 mmHg和22 mmHg阈值时升高的曲线下面积（AUC）最大，分别为0.74（95%CI：0.65 - 0.82）、0.77（95%CI：0.69 - 0.85）和0.79（95%CI：0.70 - 0.86）。
超声测量ONSD、PI比值、MCAPI和MCAFVd与ICPi测量显示出中度至低度弱相关性。ICPe对于无创准确ICP评估而言不够精确。CCAU和ONSD测量同时使用可能为接受DC的TBI患者ICP升高提供更高的准确性，尤其是在特异性方面。必须进行进一步研究以在更广泛的患者群体中验证这些发现。
