The role of optic nerve sheath ultrasonography in increased intracranial pressure: A systematic review and meta analysis

David Berhanu; Joana Cardoso Ferreira; Luís Abegão Pinto; Diana Aguiar de Sousa; Lia Lucas Neto; Joana Tavares Ferreira

doi:10.1016/j.jns.2023.120853

The role of optic nerve sheath ultrasonography in increased intracranial pressure: A systematic review and meta analysis

J Neurol Sci. 2023 Nov 15:454:120853. doi: 10.1016/j.jns.2023.120853. Epub 2023 Oct 30.

Authors

David Berhanu¹, Joana Cardoso Ferreira², Luís Abegão Pinto³, Diana Aguiar de Sousa⁴, Lia Lucas Neto⁵, Joana Tavares Ferreira³

Affiliations

¹ Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal. Electronic address: davidb@campus.ul.pt.
² Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
³ Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Oftalmologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
⁴ Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Unidade Cerebrovascular, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.
⁵ Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.

PMID: 37925899
DOI: 10.1016/j.jns.2023.120853

Abstract

Objectives: To review the optimal diagnostic cut-off of ultrasonographic optic nerve sheath diameter (ONSD) in the diagnosis of increased intracranial pressure (IICP).

Methods: A systematic search was conducted of available studies assessing the use of ONSD ultrasonography in patients with suspected IICP. Meta-analysis of diagnostic accuracy of ultrasonographic ONSD was performed using a bivariate model of random effects to summarize pooled sensitivity and specificity. A summary receiver operating characteristics (SROC) curve was plotted. Accuracy measures associated with ONSD cut-off and predefined covariates were investigated with meta-regression.

Results: We included 38 studies, comprising a total of 2824 patients. A total of 21 studies used invasive techniques as a reference standard estimation of IICP and meta-analysis revealed a pooled sensitivity of 0.90 (95% CI 0.85-0.93) and specificity of 0.87 (95% CI 0.80-0.91). Optimal ONSD cut-off values ranged between 4.1 mm and 7.2 mm. Meta-regression analysis showed that ONSD cut-off values of 5.6 to 6.3 mm were associated with higher pooled specificity compared to cut-off values of 4.9 to 5.5 mm (0.93, 95% CI 0.85-0.97 vs. 0.78, 95% CI 0.65-0.87; p = 0.036).

Conclusions: Ultrasonography of ONSD shows a high diagnostic accuracy for IICP, with high pooled sensitivity and specificity. Additionally, larger cut-off values seem to significantly increase specificity without compromising sensitivity, which support their use as optimal ONSD cut-off. The overall high sensitivity of ultrasonographic ONSD suggests its usefulness as a screening tool for IIC, which may provide an estimate of when invasive methods are warranted.

Clinical relevance: ONSD ultrasonography is a fast and cost-effective method with a high diagnostic accuracy to detect IICP. The optimum ONSD cut-off hasn't been established before, but we suggest the 5.6 to 6.3 mm range as the best for the diagnosis of IICP.

Keywords: Intracranial pressure; Optic nerve sheath; Optic nerve sheath diameter; Ultrasonography.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Intracranial Hypertension* / diagnostic imaging
Intracranial Pressure* / physiology
Optic Nerve / diagnostic imaging
Sensitivity and Specificity
Ultrasonography / methods