title: The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) measurement and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure (ICP).
  
  
  METHODS
  A total 60 patients with (cases, n=30) and without (controls, n=30) acute clinical and computed tomographic findings of elevated ICP due to intracranial mass/hemorrhage were recruited from a teaching hospital. The mean binocular and maximum ultrasonographic ONSDs, as well as the mean binocular Doppler ultrasound waveform indices of the ophthalmic arteries including pulsatility index (PI), resistive index (RI), end-systolic velocity (ESV), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were compared between the two groups.
  
  
  RESULTS
  Compared to controls, the case group had significantly higher mean binocular ONSD (5.48 ± 0.52 mm vs. 4.09 ± 0.22 mm, p<0.001), maximum ONSD (5.63 ± 0.55 mm vs. 4.16 ± 0.23 mm, p<0.001), mean PI (1.53 ± 0.16 vs. 1.45 ± 0.20, p=0.01), and mean RI (0.76 ± 0.07 vs. 0.73 ± 0.04, p=0.01). The mean EDV, in contrast, was significantly higher in controls (8.55 ± 3.09 m/s vs. 7.17 ± 2.61 m/s, p=0.01). The two groups were comparable for the mean PSV (30.73 ± 7.93 m/s in cases vs. 32.27 ± 10.39 m/s in controls, p=0.36). Among the mentioned variables, the mean binocular ONSD was the most accurate parameter in detecting elevated ICP (sensitivity and specificity of 100%, cut-off point=4.53 mm). The Doppler indices were only moderately accurate (sensitivity: 56.7-60%, specificity: 63.3-76.7%).
  
  
  CONCLUSIONS
  While the ultrasonographic mean binocular ONSD (>4.53 mm) was completely accurate in detecting elevated ICP, color Doppler indices of the ophthalmic arteries were of limited value.
authors.affiliation: Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammad Kazem
authors.initials: MK
authors.lastname: Tarzamni
authors.affiliation: Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Derakhshan
authors.affiliation: Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Meshkini
authors.affiliation: Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Merat
authors.affiliation: Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: Fouladi.daniel@yahoo.com.
authors.forename: Daniel Fadaei
authors.initials: DF
authors.lastname: Fouladi
authors.affiliation: Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samira
authors.initials: S
authors.lastname: Mostafazadeh
authors.affiliation: Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Rezakhah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging*; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath / Q000000981:diagnostic imaging*; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging*; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000592:standards*; D055815:Young Adult
keywords: Color Doppler ultrasound; Intracranial pressure; Ophthalmic artery; Optic nerve sheath diameter; Ultrasonography