Abstract：
Background Discrepancies in the literature regarding optimal optic nerve sheath diameter (ONSD) cutoffs for intracranial pressure (ICP) necessitate alternative neuroimaging parameters to improve clinical management. Purpose To evaluate the diagnostic accuracy of the dimensions of the perineural subarachnoid space to the optic nerve sheath ratio, measured using US, in predicting increased ICP. Materials and Methods In a prospective cohort study from April 2022 to December 2023, patients with suspected increased ICP underwent optic nerve US to determine the dimensions of arachnoid bulk (DAB) ratio and ONSD before invasive ICP measurement. Correlation between the parameters and ICP, as well as diagnostic accuracy, was assessed using area under the receiver operating characteristic curve (AUC) analysis. Results A total of 30 participants were included (mean age, 39 years ± 14 [SD]; 24 female). The DAB ratio and ONSD were significantly larger in participants with increased ICP (38% [0.16 of 0.42] and 14% [0.82 of 6.04 mm], respectively; P < .001). The DAB ratio showed a stronger correlation with ICP than ONSD (rs = 0.87 [P < .001] vs rs = 0.61 [P < .001]). The DAB ratio and ONSD optimal cutoffs for increased ICP were 0.5 and 6.5 mm, respectively, and the ratio had higher sensitivity (100% vs 92%) and specificity (94% vs 83%) compared with ONSD. Moreover, the DAB ratio better predicted increased ICP than ONSD, with a higher AUC (0.98 [95% CI: 0.95, 1.00] vs 0.86 [95% CI: 0.71, 0.95], P = .047). Conclusion An imaging ratio was proposed to predict ICP based on the relative anatomy of the cerebrospinal fluid space, demonstrating more accurate diagnosis of increased ICP and a strong correlation with ICP values, suggesting its potential utility as a neuroimaging marker in clinical settings. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Shepherd in this issue.
摘要：
背景技术文献中关于颅内压(ICP)的最佳视神经鞘直径(ONSD)截止值的差异需要替代的神经成像参数来改善临床管理。目的评价神经蛛网膜下腔与视神经鞘比值的诊断准确性,用美国测量，预测ICP增加。材料和方法在2022年4月至2023年12月的一项前瞻性队列研究中，怀疑ICP增加的患者在侵入性ICP测量之前接受了视神经US检查，以确定蛛网膜体积（DAB）比率和ONSD的尺寸。参数与ICP之间的相关性，以及诊断准确性，使用受试者工作特征曲线下面积(AUC)分析进行评估。结果共纳入30名参与者(平均年龄，39岁±14[SD]；24名女性）。ICP增加的参与者的DAB比率和ONSD明显更大（38％[0.42的0.16]和14％[6.04mm的0.82]，分别；P<.001）。DAB比值与ICP的相关性强于ONSD（rs=0.87[P<.001]vsrs=0.61[P<.001]）。增加ICP的DAB比率和ONSD最佳截止值分别为0.5和6.5mm，分别,与ONSD相比，该比率具有更高的敏感性（100％vs92％）和特异性（94％vs83％）。此外，DAB比率比ONSD更好地预测ICP的增加，AUC较高（0.98[95%CI：0.95，1.00]vs0.86[95%CI：0.71，0.95]，P=.047）。结论根据脑脊液空间的相对解剖，提出了一种成像比率来预测ICP。证明对ICP升高的诊断更准确，并且与ICP值具有很强的相关性，提示其在临床环境中作为神经影像学标志物的潜在效用。©RSNA,2024补充材料可用于本文。另请参阅本期Shepherd的社论。
