Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure

Koziarz, Alex; Sne, Niv; Kegel, Fraser; Nath, Siddharth; Badhiwala, Jetan H.; Nassiri, Farshad; Mansouri, Alireza; Yang, Kaiyun; Zhou, Qi; Rice, Timothy; Faidi, Samir; Passos, Edward; Healey, Andrew; Banfield, Laura; Mensour, Mark; Kirkpatrick, Andrew W.; Nassar, Aussama K.; Fehlings, Michael G.; Hawryluk, Gregory; Almenawer, Saleh A.

doi:10.7326/m19-0812

Cited by 65 publications

(37 citation statements)

References 79 publications

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“…For example, a 0.075 mm measurement error is much lower than previously reported values of interobserver variability of ±0.2 mm (30). Furthermore, this small measurement error is insignificant in comparison to the variation in reported ONSD measurement threshold values which vary as much as 1 mm in the literature (31). Some authors contend that a trend in increasing repeated ONSD measurements or extreme values is more useful in diagnosis to account for these measurement uncertainties (32).…”

Section: Discussionmentioning

confidence: 86%

Accuracy of Optic Nerve Sheath Diameter Measurements in Pocket-Sized Ultrasound Devices in a Simulation Model

et al. 2022

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IntroductionTransorbital sonographic measurement of optic nerve sheath diameter (ONSD) is an emerging non-invasive technique for the identification and monitoring of intracranial hypertension. In recent years, new pocket ultrasound devices have become available, and it is uncertain if they have the resolution to measure such small structures appropriately as compared to their predecessors. In this study, we measure the performance of three ultrasound units on a simulation model to establish their precision and accuracy.MethodsONSD was measured by three expert point-of-care sonographers using ultrasound machines three times on each of seven discrete ONS model sizes ranging from 3.5 to 7.9 mm. Two pocket ultrasounds (IVIZ, Sonosite, and Lumify, Philips) and one standard-sized portable ultrasound (M-Turbo, Sonosite) were used. Measurements were analyzed for mean error and variance and tested for significance using blocked covariance matrix regression analyses.ResultsThe devices differed in their variances (Lumify: 0.19 mm2, M-Turbo: 0.26 mm2, IVIZ: 0.34 mm2) and their mean error (Lumify: −0.05 mm, M-Turbo: 0.10 mm, IVIZ: −0.10 mm). The difference in mean error between users is not significant (p = 0.45), but there is a significant difference in mean error between devices (p = 0.02).ConclusionsAccurate ONSD measurement is possible utilizing pocket-sized ultrasound, and in some cases, may be more accurate than larger portable ultrasound units. While the differences in these devices were statistically significant, all three were highly accurate, with one pocket device (Lumify) outperforming the rest. Further study in human subjects should be conducted prior to using pocket ultrasound devices for in vivo diagnosis of intracranial hypertension.

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Section: Discussionmentioning

confidence: 86%

Accuracy of Optic Nerve Sheath Diameter Measurements in Pocket-Sized Ultrasound Devices in a Simulation Model

et al. 2022

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“…A recent systematic review and meta-analysis of 71 studies, inclusive of adult and pediatric populations, report pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ONSD measurements to be 97% (95% CI 92-99%), 86% (CI 74-93%), 6.93 (CI 3.55-13.54), and 0.04 (CI 0.02-0.10), respectively [10]. However, in contrast to our study, the included papers used in their meta-analysis predominantly come from a patient population with known intracranial pathology (18 with traumatic brain injury, 26 without and 27 mixed).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies found that increase in ONSD correlates with increase in ICP [6][7][8][9]. Meta-analyses and systematic reviews support use of ONSD as a non-invasive ICP assessment modality [10]. However, different studies report variable inter-rater agreement and wide confidence intervals in measurements, suggesting caution-pending larger and more comprehensive studies [3,11,12].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound measurement of optic nerve sheath diameter pre- and post-lumbar puncture

et al. 2020

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Background: To test the hypothesis that optic nerve sheath diameter (ONSD) correlates with real-time changes in intracranial pressure, we performed ultrasound measurements of the ONSD in ambulatory patients undergoing elective lumbar puncture (LP). We conducted a prospective cohort study, including adult patients undergoing LP in a non-emergent setting. We measured ONSD perpendicular to the optic nerve at 3 mm behind the globe in both eyes in the traverse and sagittal planes, with the patient supine. The primary outcome was change in ONSD from pre-LP to post-LP. We calculated association of opening and closing LP pressures with changes in the pre-and post-LP ONSD measurements. Results: The mean patient age was 49.0 years (SD = 37-61, range 19-67) with 21 females (72.4%) and 26 (89.7%) white American (not Hispanic or Latino). The average opening pressure and closing pressures were 20.4 cm and 13.5 cm with a difference of 6.9 cm, (95% CI 3.9-10.0 cm). Pressures between the participants with baseline ONSD measurement > 5 mm (average opening pressure = 21.3 cm) to those < 5 mm (20.2 cm) differed by 1.1 cm (95% CI − 5.7 to 8.0). Linear regression revealed no association between the sagittal, transverse, average, and change in ONSD measurements with the observed LP opening pressure, change in LP pressure, or volume of cerebral spinal fluid (CSF) drained. Conclusions: In this study of ambulatory patients undergoing rapid decreases in ICP via elective LP, we detected no acute changes in ultrasonographic measurement of the ONSD.

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“… 1 Still, ICP monitoring is invasive and requires insertion of a probe or catheter into the intracranial compartment, thereby carrying a risk of complications. 2 , 3 A wide range of noninvasive methods of measuring the static and pulsatile components of ICP have been explored, 1 , 4 – 11 but so far, none have been found clinically suitable.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography

Jacobsen

Jørstad

Moe

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose To explore the ability of optical coherence tomography (OCT) to noninvasively estimate pulsatile and static intracranial pressure (ICP). Methods An OCT examination was performed in patients who underwent continuous overnight monitoring of the pulsatile and static ICP for diagnostic purpose. We included two patient groups, patients with idiopathic intracranial hypertension (IIH; n = 20) and patients with no verified cerebrospinal fluid disturbances (reference; n = 12). Several OCT parameters were acquired using spectral-domain OCT (RS-3000 Advance; NIDEK, Singapore). The ICP measurements were obtained using a parenchymal sensor (Codman ICP MicroSensor; Johnson & Johnson, Raynham, MA, USA). The pulsatile ICP was determined as the mean ICP wave amplitude (MWA), and the static ICP was determined as the mean ICP. Results The peripapillary Bruch's membrane angle (pBA) and the optic nerve head height (ONHH) differed between the IIH and reference groups and correlated with both MWA and mean ICP. Both OCT parameters predicted elevated MWA. Area under the curve and cutoffs were 0.82 (95% confidence interval [CI], 0.66–0.98) and -0.65° (sensitivity/specificity; 0.75/0.92) for pBA and 0.84 (95% CI, 0.70–0.99) and 405 µm (0.88/0.67) for ONHH. Adjusting for age and body mass index resulted in nonsignificant predictive values for mean ICP, whereas the predictive value for MWA remained significant. Conclusions This study provides evidence that the OCT parameters pBA and ONHH noninvasively can predict elevated pulsatile ICP, represented by the MWA. Translational Relevance OCT shows promise as a method for noninvasive estimation of ICP.

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Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure

Cited by 65 publications

References 79 publications

Accuracy of Optic Nerve Sheath Diameter Measurements in Pocket-Sized Ultrasound Devices in a Simulation Model

Accuracy of Optic Nerve Sheath Diameter Measurements in Pocket-Sized Ultrasound Devices in a Simulation Model

Ultrasound measurement of optic nerve sheath diameter pre- and post-lumbar puncture

Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography

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