Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement

Abstract

Background: Ultrasonograpic retrobulbar optic nerve sheath diameter (ONSD) measurement is considered to be an alternative noninvasive method to estimate intracranial pressure,but the further validation is urgently needed. The aim of the current study was to investigate the association of the ultrasonographic ONSD and intracranial pressure (ICP) in patients.

Methods: One hundred and ten patients whose intracranial pressure measured via lumbar puncture were enrolled in the study. Their retrobulbar ONSD with B-scan ultrasound was determined just before lumber puncture. The correlation between the ICP and the body mass index (BMI), ONSD or age was established respectively with the Pearson correlation coefficient analysis. The discriminant analysis was used to obtain a discriminant formula for predicting ICP with the ONSD、BMI、gender and age. Another 20 patients were recruited for further validation the efficiency of this discriminant equation.

Results: The mean ICP was 215.3 ± 81.2 mmH₂O. ONSD was 5.70 ± 0.80 mm in the right eye and 5.80 ± 0.77 mm in the left eye. A significant correlation was found between ICP and BMI (r = 0.554, p < 0.001), the mean ONSD (r = 0.61, P < 0.001), but not with age (r = -0.131, p = 0.174) and gender (r = 0.03, p = 0.753). Using receiver operating characteristic (ROC) curve analysis, the critical value for the risk mean-ONSD was 5.6 mm from the ROC curve, with the sensitivity of 86.2% and specificity of 73.1%. With 200 mmH₂O as the cutoff point for a high or low ICP, stepwise discriminant was applied, the sensitivity and specificity of ONSD predicting ICP was 84.5%-85.7% and 86.5%-92.3%.

Conclusions: Ophthalmic ultrasound measurement of ONSD may be a good surrogate of invasive ICP measurement. This non-invasive method may be an alternative approach to predict the ICP value of patients whose ICP measurement via lumbar puncture are in high risk. The discriminant formula, which incorporated the factor of BMI, had similar sensitivity and higher specificity than the ROC curve.

Keywords: B-scan ultrasonography; Intracranial pressure; Optic nerve sheath diameter.

Fig. 1

Patient recruitment flow chart

Fig. 2

The correlation of retrobulbar optic nerve sheath diameter measured in the right eye and in the left eye. Scatter plot of ONSD shows good correlation between two eyes (r = 0.656, P < 0.001)

Fig. 3

The scatter plot of intracranial pressure (ICP) and the mean optic nerve sheath diameter (ONSD-mean) of both eyes and intracranial pressure and the body mass index. ICP was significantly associated with the mean ONSD (r = 0.61, P < 0.001) (a) and BMI (r = 0.55, P < 0.001) (b), not associated with age (r = −0.131, P = 0.174) (c) or gender (r = 0.03, P = 0.753) (d). In Fig. D,1 is male, 2 is female

Fig. 4

Receiver operating characteristic (ROC) curve for the mean-ONSD. The area under the curve (AUC) of 0.861 means that 86.1% of the time, a randomly selected individual who with intracranial hypertension has a wider mean-ONSD than that of patients who with normal intracranial pressure

Fig. 5

The scan images of ONSD measurement with B-scan ultrasound. a is the picture of ultrasonic measurement of ONSD in a high intracranial pressure patient. In this picture, there is a more significant subarachnoid space around optic nerve. b is the picture of ultrasonic measurement of ONSD in a normal intracranial pressure patient