Background

Qualitative, noninvasive assessment of intracranial pressure is of eminent importance in pediatric patients in many clinical situations and can reliably be performed using transorbital ultrasonographic measurement of the optic nerve sheath diameter (ONSD). MRI-based determination of ONSD can serve as an alternative if ultrasound (US) is not possible or available for various reasons, for example, in small, incompliant children. This study investigates repeatability and observer reliability of US ONSD and correlation and bias of US- versus MRI-based ONSD assessment in pediatric patients.

Methods

One hundred fifty children diagnosed with tumor (n = 40), hydrocephalus (n = 42), and other cranial pathologies (n = 68) were included. Bilateral ONSD was quantified by US using a 12-MHz linear array transducer. This was compared with ONSD measured in simultaneously acquired (≤24 h) T2-weighted MRI scans of the orbit.

Results

Repeatability of individual US values and intraobserver ONSD was outstanding (Cronbach's α = 0.984 and 0.996, respectively). Overall mean values for ONSD were 5.8 ± 0.88 mm and 5.7 ± 0.89 mm for US and MRI, respectively. Correlation between US and MRI-based ONSD was strong (r = 0.976, P < 0.01). Bland and Altman analysis showed a mean bias of 0.078 mm. A repeated-measures correlation (r_rm) in 9 patients showed an excellent value (r_rm = 0.94, P < 0.01).

Conclusions

Repeatability and reliability of US ONSD determination is excellent. In case US ONSD assessment is not possible or available, MRI scans can serve as an excellent alternative. The difference of US and MRI ONSD is minimal and insignificant, and thus, both techniques can complement each other.

中文翻译：

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儿童 B 扫描超声和基于 MRI 的视神经鞘直径 (ONSD) 测量的比较

背景

颅内压的定性、无创评估在许多临床情况下对儿科患者非常重要，并且可以使用视神经鞘直径 (ONSD) 的经眶超声测量可靠地进行。如果超声 (US) 由于各种原因（例如，在小的、不顺从的儿童中）无法使用或无法使用，则基于 MRI 的 ONSD 确定可以作为替代方法。本研究调查了美国 ONSD 的可重复性和观察者可靠性，以及美国与基于 MRI 的 ONSD 评估在儿科患者中的相关性和偏差。

方法

包括 150 名被诊断患有肿瘤 (n = 40)、脑积水 (n = 42) 和其他颅脑病变 (n = 68) 的儿童。US 使用 12-MHz 线性阵列传感器对双侧 ONSD 进行量化。这与在同时获得的（≤24 小时）T2 加权 MRI 眼眶扫描中测量的 ONSD 进行了比较。

结果

单个 US 值和观察者内 ONSD 的可重复性非常出色（分别为 Cronbach's α = 0.984 和 0.996）。对于 US 和 MRI，ONSD 的总体平均值分别为 5.8 ± 0.88 mm 和 5.7 ± 0.89 mm。US 和基于 MRI 的 ONSD 之间的相关性很强（r = 0.976，P  < 0.01）。Bland 和 Altman 分析显示平均偏差为 0.078 mm。9 名患者的重复测量相关性 (r _rm ) 显示出极好的值 (r _rm  = 0.94, P  < 0.01)。

结论

美国 ONSD 测定的重复性和可靠性非常好。如果美国 ONSD 评估不可行或不可用，MRI 扫描可以作为一个很好的选择。US 和 MRI ONSD 的差异很小且不显着，因此两种技术可以相互补充。