title: Optic nerve sheath diameter threshold by ocular ultrasonography for detection of increased intracranial pressure in Korean adult patients with brain lesions.
abstract: Optic nerve sheath diameter (ONSD) seen on ocular US has been associated with increased intracranial pressure (IICP). However, most studies have analyzed normal range of ONSD and its optimal cut-off point for IICP in Caucasian populations. Considering ONSD differences according to ethnicity, previous results may not accurately reflect the association between IICP and ONSD in Koreans. Therefore, we conducted this study to investigate normal range of ONSD and its optimal threshold for detecting IICP in Korean patients.This prospective multicenter study was performed for patients with suspected IICP. ONSD was measured 3 mm behind the globe using a 13-MHz US probe. IICP was defined as significant brain edema, midline shift, compression of ventricle or basal cistern, effacement of sulci, insufficient gray/white differentiation, and transfalcine herniation by radiologic tests. The results of the ONSD are described as the median (25th-75th percentile). The differences of ONSD according to disease entity were analyzed. A receiver operator characteristic (ROC) curve was generated to determine the optimal cut-off point for identifying IICP.A total of 134 patients were enrolled. The patients were divided into 3 groups as follows: patients with IICP, n = 81 (60.5%); patients without IICP, n = 27 (20.1%); and control group, n = 26 (19.4%). ONSD in patients with IICP (5.9 mm [5.8-6.2]) is significantly higher than those without IICP (5.2 mm [4.8-5.4]) (P < 0.01) and normal control group (4.9 mm [4.6-5.2]) (P < 0.001). Between patients without IICP and normal control group, the difference of ONSD did not reach statistical significance (P = 0.31). ONSD >5.5 mm yielded a sensitivity of 98.77% (95% CI: 93.3%-100%) and a specificity of 85.19% (95% CI: 66.3%-95.8%).In conclusion, the optimal cut-off point of ONSD for identifying IICP was 5.5 mm. ONSD seen on ocular US can be a feasible method for detection and serial monitoring of ICP in Korean adult patients.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam Department of Neurosurgery, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon Department of Anesthesiology and Pain Medicine Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul Department of Radiology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon Department of Neurosurgery, Catholic University College of Medicine, Incheon St. Mary's Hospital, Incheon, Korea.
authors.forename: Si Un
authors.initials: SU
authors.lastname: Lee
authors.forename: Jin Pyeong
authors.initials: JP
authors.lastname: Jeon
authors.forename: Hannah
authors.initials: H
authors.lastname: Lee
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Mingu
authors.initials: M
authors.lastname: Seo
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Byoun
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.forename: Ho Geol
authors.initials: HG
authors.lastname: Ryu
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Heung Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Kyung-Sool
authors.initials: KS
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D001927:Brain Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012372:ROC Curve; D056910:Republic of Korea / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult