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Contrast enhanced ultrasound imaging of the optic nerve sheath diameter – what are we really measuring?

Background

Several studies on pediatric and adult population proposed measurment of optic nerve sheath diameter (ONSD) as a noninvasive marker of increased intracranial pressure (ICP). Only few studies were made correlating MRI measurment of ONSD with ultrasound measurment of ONSD. Overall lower standard values of the ONSD for ultrasound measurment compared to MRI measurment were found. That might be atribbuted to variable interpretation of ultrasound anatomy – what are we really measuring?

Objective

We performed a proof of concept study to evaluate the accuracy of measurments of the ONSD for contrast enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI). Second generation contrast agent (Sonovue™, Bracco SpA) was used to enhance the ultrasound recognition of relevant anatomy and conduct transbulbar ONSD measurments.

Patients and methods

Nine healthy volunteers were examined with CEUS with transbulbar approach and MRI. CEUS and MRI examinations were recorded on the PACS system. Measurments of the ONSD were performed on the collected images using DICOM viewing software (OsiriX™, Pixmeo SARL). Statistical analysis was performed and included the calculation of the agreement of measurment between both methods. Statistical software was used (IBM SPSS Statistics ver. 20™, IBM Corp).

Results

Good correlation of measurment values was found between CEUS and MRI (ICC 0.98, 95% CI, 0.74 – 0.99), MRI being regarded as a gold standard.

Conclusion

Using CEUS significantly aids the identification and recognition of the relevant structures sorrounding the optic nerve. Measuring a small structure as ONSD with ultrasound is a demanding task. By using CEUS the exact measuring points can be quickly and easilly identified, making a measurment more exact using transbulbar sonography on living subjects. The measurment can be quickly performed, can be repeated, the introduced contrast agent is nontoxic

References

  1. 1.

    Beare NAV, Kampondeni S, Glover SJ, Molyneux E, Taylor TE, Harding SP, et al.: Detection of raised intracranial pressure by ultrasound measurement of optic nerve sheath diameter in African children. Trop. Med. Int. Health 2008,13(11):1400–4. 10.1111/j.1365-3156.2008.02153.x

    PubMed Central  PubMed  Article  Google Scholar 

  2. 2.

    Karakitsos D, Soldatos T, Gouliamos A, Armaganidis A, Poularas J, Kalogeromitros A, et al.: Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury. Transplant. Proc 2006,38(10):3700–6. 10.1016/j.transproceed.2006.10.185

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL: Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011,15(3):506–15. 10.1007/s12028-011-9606-8

    PubMed  Article  Google Scholar 

  4. 4.

    Moretti R, Pizzi B, Cassini F, Vivaldi N: Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 2009,11(3):406–10. 10.1007/s12028-009-9250-8

    PubMed  Article  Google Scholar 

  5. 5.

    Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al.: Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007,33(10):1704–11. 10.1007/s00134-007-0797-6

    PubMed  Article  Google Scholar 

  6. 6.

    Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA: Utility of optic nerve ultrasonography in head injury. Injury 2008,39(5):519–24. 10.1016/j.injury.2007.09.029

    PubMed  Article  Google Scholar 

  7. 7.

    Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A: Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 2009,26(9):630–4. 10.1136/emj.2008.058453

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Kimberly HH, Noble VE: Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care 2008,12(5):181. 10.1186/cc7008

    PubMed Central  PubMed  Article  Google Scholar 

  9. 9.

    McAuley D, Paterson A, Sweeney L: Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus. Childs Nerv Syst 2009,25(1):87–90. 10.1007/s00381-008-0713-6

    PubMed  Article  Google Scholar 

  10. 10.

    Sutherland AI, Morris DS, Owen CG, Bron AJ, Roach RC: Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study. Br J Sports Med 2008,42(3):183–8. 10.1136/bjsm.2007.045286

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Newman WD, Hollman AS, Dutton GN, Carachi R: Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 2002,86(10):1109–13. 10.1136/bjo.86.10.1109

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  12. 12.

    Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M: Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Annals of Emergency Medicine 2007,49(4):508–14. 10.1016/j.annemergmed.2006.06.040

    PubMed  Article  Google Scholar 

  13. 13.

    Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Camargo CA, Harris NS: Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure. J Appl Physiol 2009,106(4):1207–11. 10.1152/japplphysiol.01188.2007

    PubMed  Article  Google Scholar 

  14. 14.

    Blaivas M, Theodoro D, Sierzenski PR: Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003,10(4):376–81. 10.1111/j.1553-2712.2003.tb01352.x

    PubMed  Article  Google Scholar 

  15. 15.

    Steinborn M, Fiegler J, Kraus V, Denne C, Hapfelmeier A, Wurzinger L, et al.: High resolution ultrasound and magnetic resonance imaging of the optic nerve and the optic nerve sheath: anatomic correlation and clinical importance. Ultraschall Med 2011,32(6):608–13. 10.1055/s-0029-1245822

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J: Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. In YMEM. Volume 53. American College of Emergency Physicians; 2009:785–91.

  17. 17.

    Rifenburg RP, Williams JJ: Optic nerve head drusen: a case of false-positive papilledema discovered by ocular ultrasound in the emergency department. Crit Ultrasound J 2010,2(2):75–6. 10.1007/s13089-010-0036-1

    Article  Google Scholar 

  18. 18.

    Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A: Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 2008,12(3):R67. 10.1186/cc6897

    PubMed Central  PubMed  Article  Google Scholar 

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Correspondence to Andrej Bergauer.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Bergauer, A., Prosen, G., Flis, V. et al. Contrast enhanced ultrasound imaging of the optic nerve sheath diameter – what are we really measuring?. Crit Ultrasound J 4, A2 (2012). https://doi.org/10.1186/2036-7902-4-S1-A2

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Keywords

  • Magnetic Resonance Imaging
  • Contrast Agent
  • Magnetic Resonance Imaging Examination
  • Ultrasound Measurment
  • Optic Nerve Sheath Diameter