Optimal Optic Nerve Sheath Diameter Threshold for the Identification of Elevated Opening Pressure on Lumbar Puncture in a Chinese Population

Abstract

Ultrasonography of the optic nerve sheath diameter (ONSD) is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure (ICP). The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture (LP) in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001). However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

Effects of Sevoflurane and Propofol on the Optic Nerve Sheath Diameter in Patients Undergoing Laparoscopic Gynecological Surgery: A Randomized Controlled Clinical Studies&nbsp;

“…In addition, the patients in that study were from western countries, and the ONSD varied among different races. Wang et al found that among the Chinese population, the predicted cut-off value of ONSD that means intracranial pressure higher than 20 cmH2O was lower than that in Caucasians [27].…”

Noninvasive Monitoring and Neurointerventional Management of Idiopathic Intracranial Hypertension

“…These methods have been used to detect elevated ICP with sensitivity and specificity ranging from 84 to 98% and 42 to 92%, respectively (►Table 1). [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] The values can be compared with the results of two different meta-analyses from 2011 and 2015 that demonstrated the ability of ONSD ultrasonography to yield average sensitivity and specificity ranging from 90 to 95% and 85 to 92%, respectively. 29,30 A more recent meta-analysis found sensitivity and specificity to range from 88 to 95% and 74 to 96%, respectively.…”

Noninvasive methods of detecting increased intracranial pressure

“…There have also been a number of studies that compared ocular ultrasound-derived ONSD with ICP measured by LP opening pressure or invasive monitoring. In the adult population, the literature shows evidence for cutoff values ranging from 4.1 to 5.7 mm, which are associated with 74.1 to 100 % sensitivity and 74 to 100 % specificity [35,36]. Interestingly, [37].…”