Interrater reliability of emergency medicine residents in measurement of optic nerve sheath diameter with computed tomography

Background and objectives: To date, no study has investigated the ability of optic nerve sheath diameter calculated from non-contrast brain computed tomography to predict acute cerebellar infarction in patients with acute vertigo. The aim of our study was to evaluate the predictive utility of optic nerve sheath diameter for diagnosing acute cerebellar infarction in patients with acute vertigo without computed tomography abnormalities. Methods: We retrospectively enrolled patients with acute vertigo without computed tomography abnormalities who underwent magnetic resonance imaging including diffusion-weighted imaging at our emergency department between January 2016 and December 2017. Two emergency physicians independently measured optic nerve sheath diameter at 3 mm (ONSD3) and 10 mm (ONSD10) behind the globe in each patient. Final magnetic resonance imaging reports with clinical progress notes were used as the reference standard. A multivariate logistic regression analysis, receiver operating characteristic curves, and intra-class correlation coefficients were calculated to estimate predictive value. Results: A total of 34 patients (16.1%) were diagnosed with acute infarction and 177 patients (83.9%) were diagnosed with peripheral vertigo. Mean ONSD3 ( p < 0.001) and ONSD10 ( p < 0.001) were independent predictive factors for distinguishing acute infarction and peripheral vertigo. ONSD3 (cut-off = 4.22 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 97.7% (95% confidence interval = 95.1–99.6) specificity with area under the receiver operating characteristic curve of 0.988 (95% confidence interval = 0.978–1.0), while ONSD10 (cut-off = 3.63 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 87.6% (95% confidence interval = 81.8–92.0) specificity with area under the receiver operating characteristic curve of 0.976 (95% confidence interval = 0.959–0.997). There were good inter- and intra-observer agreements for both sides of ONSD3 and ONSD10 (intra-class correlation coefficient range = 0.652–0.773). Conclusion: Optic nerve sheath diameter, in particular OSND3, is a feasible predictive marker for acute infarction in patients with acute vertigo without computed tomography abnormalities. This information can assist decision-making in ordering brain magnetic resonance imaging for the assessment of acute vertigo.

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Relationship between optic nerve sheath diameter on initial brain computed tomography and neurologic outcome in post-cardiac arrest patients with therapeutic hypothermia

Resuscitation ◽

10.1016/j.resuscitation.2015.09.317 ◽

2015 ◽

Vol 96 ◽

pp. 133

Author(s):

Eunsil Ko ◽

Minjung Kathy Chae ◽

Jeong Hoon Lee ◽

Tae Rim Lee ◽

Min Seob Sim ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Optic Nerve ◽

Therapeutic Hypothermia ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Neurologic Outcome ◽

Brain Computed Tomography ◽

Nerve Sheath

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The relationship between computed tomography measurement of the optic nerve sheath diameter and elevated intracranial pressure in non-trauma patients

South African Journal of Radiology ◽

10.4102/sajr.v20i1.1060 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Daniël Luyt ◽

Delmé Hurter ◽

Gina Joubert

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Intracranial Pressure ◽

Digital Images ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Trauma Patients ◽

Cross Sectional ◽

Nerve Sheath ◽

The Brain

Background: The early detection and treatment of raised intracranial pressure (ICP) is critical in the prevention of mortality and morbidity as a result of secondary ischemic brain injury. Measuring the optic nerve sheath diameter (ONSD) on computed tomography (CT) to predict raised ICP may be useful in cases where routine CT investigations of the brain are indicated and invasive ICP monitoring is not available, or a lumbar puncture (LP) is contraindicated.Objective: The purpose of this study was to determine if the ONSD can be measured on digital images obtained by routine CT investigations of the brain, to identify patients with non-traumatic causes of elevated ICP, and to provide the observer with a non-invasive, objective measurement to predict elevated ICP.Method: We conducted a cross-sectional, retrospective analysis of anonymised patient data, comparing the ONSD on CT imaging with the opening pressure manometry during LP on patients who presented with focal neurology or with a Glasgow coma scale score of less than 15. The study sample consisted of 67 patients, ≥18 years of age, treated at the emergency department of the Kimberly Hospital Complex from 01 March 2013 to 31 December 2014.Results: An ONSD measurement of ≥4.8 mm identified patients with an elevated ICP with a sensitivity of 92.9% and a specificity of 97.6%, using a 95% confidence interval. Raising the ONSD cut-off value to ≥5.0 mm decreased the sensitivity to 85.7% but increased the specificity to 100%, eliminating all patients with a normal ICP.Conclusion: The ONSD can be measured on digital images obtained by routine CT investigations of the brain to predict elevated ICP in non-trauma patients, ≥18 years of age, with acceptable sensitivity and specificity.

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