The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions

Abstract

Background The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients. Methods A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses. Results The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486–0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548–0.874, P = 0.014) for the ONSD/ETD ratio. Conclusions The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

“…In addition, while ONSD alone tends to have a sizable overlap between the confidence intervals of “normal” and “elevated” ICP, ONSD‐ETD ratio did not, suggesting higher precision 59,61–64 . ONSD‐ETD ratio also had higher sensitivity and specificity for the prediction of poor neurological outcomes in patients with supratentorial injuries 65 . Two studies compared the accuracy of ONSD‐ETD ratio to ONSD alone in the detection of elevated ICP.…”

“…59,[61][62][63][64] ONSD-ETD ratio also had higher sensitivity and specificity for the prediction of poor neurological outcomes in patients with supratentorial injuries. 65 Two studies compared the accuracy of ONSD-ETD ratio to ONSD alone in the detection of elevated ICP. One study ICP showed insufficient discriminative accuracy in detecting elevated ICP between the two measurements.…”

Prognostic values of optic nerve sheath diameter for comatose patients with acute stroke: An observational study

“…The mortality noticeably increased in comatose patients with acute stroke when the ONSD was > 5.0 mm or the ONSD/ETD ratio was > 0.25[ 15 ]. Our previous study indicated that ONSD > 6.4 mm or ONSD/ETD ratio > 0.25 predicted the poor prognosis of comatose patients with supratentorial lesions[ 21 ]. The ONSD/ETD ratio was negatively correlated with glasgow outcome scale score ( r = -0.64)[ 22 ].…”

Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke

“…Due to the strong correlation between ONSD and ETD ( 12 ), the ONSD/ETD ratio has been introduced as a surrogate metric of ONSD accounting for interindividual variability due to orbit size ( 13 , 21 ). Several researches have reported that changes in the ONSD/ETD ratio are more effective than ONSD in detecting increased ICP ( 13 , 14 , 22 , 23 ). Albert et al ( 24 ) found that an ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than 0.232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.…”