J Korean Soc Emerg Med.  2019 Apr;30(2):183-189. 10.0000/jksem.2019.30.2.183.

The comparison of optic nerve sheath diameter measured by computed tomography and ultrasonography in evaluating increased intracranial pressure

• Sung BY
• Hong DY
• Kim SY
• Kim JW
• Park SO
• Lee KR
• Baek KJ

• KMID: 2447771
• DOI: http://doi.org/10.0000/jksem.2019.30.2.183

Abstract

OBJECTIVE
While the optic nerve sheath diameter (ONSD) is measured by computed tomography and ultrasonography as an indicator of an elevation in the intracranial pressure (ICP), it is unclear which ONSD measurement is useful for predicting an increased ICP. This study examined the comparability between the ONSD measured by computed tomography and ultrasonography.
METHODS
A prospective study of 150 patients in the emergency center was performed. The ONSD was measured 3 mm behind the globe of all patients by computed tomography and ultrasonography. The receiver operator characteristic (ROC) curve was analyzed to determine the diagnostic utility of detecting ICP through ONSD.
RESULTS
A total of 150 patients were enrolled. Thirty-three patients (22.0%) were found to have an increased ICP. The ONSD in patients with increased ICP was significantly higher than that of normal ICP patients measured by computed tomography and ultrasonography. Moreover, computed tomography and ultrasonography revealed an area under the ROC curve value of 0.886 and 0.933, respectively. The ONSD measurement by computed tomography and ultrasonography produced similar results (P=0.256).
CONCLUSION
The ONSD measured by computed tomography and ultrasonography is a valuable indicator of an ICP elevation. Therefore, either of the two diagnostic methods for monitoring the ICP can be used in patients with a critical care and resource-limited setup.

Keyword

Optic nerve; Computed tomography; Ultrasonography; Intracranial pressure

MeSH Terms

Critical Care
Emergencies
Humans
Intracranial Pressure*
Optic Nerve*
Prospective Studies
ROC Curve
Ultrasonography*