Pulsatile Dynamics of the Optic Nerve Sheath and Intracranial Pressure: An Exploratory In Vivo Investigation.
Pulsatile Dynamics of the Optic Nerve Sheath and Intracranial Pressure: An Exploratory In Vivo Investigation.
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DOI：
10.1227/neu.0000000000001200
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发表时间：
2016-07
期刊：
影响因子：
4.8
通讯作者：
Selbekk T
中科院分区：
文献类型：
--
作者：
Padayachy L;Brekken R;Fieggen G;Selbekk T
颅内压（ICP）升高可能导致视神经鞘（ONS）僵硬度增加。目的：建立一种分析经眶超声ONS动态的方法，探讨颅内压升高患者与正常颅内压患者之间的潜在差异。我们回顾性分析了16例患者（≤12岁）的数据，这些患者在侵入性ICP测量之前从双眼获得了ONS的超声图像序列。8例患者颅内压≥20 mm Hg。通过超声估计脑室两侧的横向运动，并采用傅里叶分析提取与心率对应的位移大小。通过计算ONS两侧位移之间的归一化绝对差，可以获得ONS变形的度量。这个参数被称为可变形性指数。根据我们的假设，由于变形能力与刚度呈负相关，我们预计在ICP≥20 mm Hg时，该参数比ICP <20 mm Hg时要低。采用单侧Mann-Whitney U检验进行统计比较。ICP≥20 mm Hg组的变形能力指数明显降低（中位数0.11 vs 0.24, P = 0.002）。我们提出了一种方法，评估使用经眶超声成像的ONS脉冲动力学。患者组之间的显著差异表明，ONS的可变形性可能与ICP升高的非侵入性标志物有关。临床意义是有希望的，应该在未来的临床研究中进行调查。AUC，曲线下面积ICP，颅内压ONS，视神经鞘ONSD，视神经鞘直径ROC，接收机工作特性
Raised intracranial pressure (ICP) may lead to increased stiffness of the optic nerve sheath (ONS). To develop a method for analyzing ONS dynamics from transorbital ultrasound and investigate a potential difference between patients with raised ICP vs normal ICP. We retrospectively analyzed data from 16 patients (≤12 years old) for whom ultrasound image sequences of the ONS had been acquired from both eyes just before invasive measurement of ICP. Eight patients had an ICP ≥20 mm Hg. The transverse motion on each side of the ONS was estimated from ultrasound, and Fourier analysis was used to extract the magnitude of the displacement corresponding to the heart rate. By calculating the normalized absolute difference between the displacements on each side of the ONS, a measure of ONS deformation was obtained. This parameter was referred to as the deformability index. According to our hypothesis, because deformability is inversely related to stiffness, we expected this parameter to be lower for ICP ≥20 mm Hg compared with ICP <20 mm Hg. The one-sided Mann-Whitney U test was used for statistical comparison. The deformability index was significantly lower in the group with ICP ≥20 mm Hg (median value 0.11 vs 0.24; P = .002). We present a method for assessment of ONS pulsatile dynamics using transorbital ultrasound imaging. A significant difference was noted between the patient groups, indicating that deformability of the ONS may be relevant as a noninvasive marker of raised ICP. The clinical implications are promising and should be investigated in future clinical studies. AUC, area under curve ICP, intracranial pressure ONS, optic nerve sheath ONSD, optic nerve sheath diameter ROC, receiver operating characteristic