Noninvasive intracranial pressure assessment by optic nerve sheath diameter: Automated measurements as an alternative to clinician-performed measurements.

Autor:	Netteland DF; Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway., Aarhus M; Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway., Smistad E; Department of Health Research, Medical Technology, SINTEF, Trondheim, Norway., Sandset EC; Department of Neurology, Oslo University Hospital Ullevål, Oslo, Norway.; The Norwegian Air Ambulance Foundation, Oslo, Norway., Padayachy L; Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa., Helseth E; Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway.; Faculty of Medicine, University of Oslo, Oslo, Norway., Brekken R; Department of Health Research, Medical Technology, SINTEF, Trondheim, Norway.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2023 Feb 01; Vol. 14, pp. 1064492. Date of Electronic Publication: 2023 Feb 01 (Print Publication: 2023).
DOI:	10.3389/fneur.2023.1064492
Abstrakt:	Introduction: Optic nerve sheath diameter (ONSD) has shown promise as a noninvasive parameter for estimating intracranial pressure (ICP). In this study, we evaluated a novel automated method of measuring the ONSD in transorbital ultrasound imaging. Methods: From adult traumatic brain injury (TBI) patients with invasive ICP monitoring, bedside manual ONSD measurements and ultrasound videos of the optic nerve sheath complex were simultaneously acquired. Automatic ONSD measurements were obtained by the processing of the ultrasound videos by a novel software based on a machine learning approach for segmentation of the optic nerve sheath. Agreement between manual and automated measurements, as well as their correlation to invasive ICP, was evaluated. Furthermore, the ability to distinguish dichotomized ICP for manual and automatic measurements of ONSD was compared, both for ICP dichotomized at ≥20 mmHg and at the 50th percentile (≥14 mmHg). Finally, we performed an exploratory subgroup analysis based on the software's judgment of optic nerve axis alignment to elucidate the reasons for variation in the agreement between automatic and manual measurements. Results: A total of 43 ultrasound examinations were performed on 25 adult patients with TBI, resulting in 86 image sequences covering the right and left eyes. The median pairwise difference between automatically and manually measured ONSD was 0.06 mm (IQR -0.44 to 0.38 mm; p = 0.80). The manually measured ONSD showed a positive correlation with ICP, while automatically measured ONSD showed a trend toward, but not a statistically significant correlation with ICP. When examining the ability to distinguish dichotomized ICP, manual and automatic measurements performed with similar accuracy both for an ICP cutoff at 20 mmHg (manual: AUC 0.74, 95% CI 0.58-0.88; automatic: AUC 0.83, 95% CI 0.66-0.93) and for an ICP cutoff at 14 mmHg (manual: AUC 0.70, 95% CI 0.52-0.85; automatic: AUC 0.68, 95% CI 0.48-0.83). In the exploratory subgroup analysis, we found that the agreement between measurements was higher in the subgroup where the automatic software evaluated the optic nerve axis alignment as good as compared to intermediate/poor. Conclusion: The novel automated method of measuring the ONSD on the ultrasound videos using segmentation of the optic nerve sheath showed a reasonable agreement with manual measurements and performed equally well in distinguishing high and low ICP. Competing Interests: ECS was employed by The Norwegian Air Ambulance Foundation. LP is a medical advisor to Nisonic AS. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Netteland, Aarhus, Smistad, Sandset, Padayachy, Helseth and Brekken.)
Databáze:	MEDLINE
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