眼-颈一体超声在特发性颅内压增高及颅内静脉窦血栓中的应用价值

The clinical value of eye-neck integrated ultrasound in idiopathic intracranial hypertension and cerebral venous sinus thrombosis

目的研究眼部超声及颈静脉超声在特发性颅内压增高(IIH)及颅内静脉窦血栓(CVST)中的应用价值。方法回顾性纳入2017年1月至2019年12月于吉林大学白求恩第一医院神经内科住院治疗的新诊断的IIH患者20例、CVST患者25例,所有的患者需完成眼部超声及颈部静脉超声检查。收集年龄、性别和BMI匹配的对照组40例。比较IIH、CVST及对照组视神经鞘宽度(ONSD)、颈内静脉远段(IJV-J3)的横截面积(CSA)、时间平均血流速度(TAMV)、血流量(BFV)及颈静脉瓣关闭不全(IJVVI)发生的频率。探讨眼-颈一体超声在IIH和CVST的临床应用价值。结果IIH患者ONSD显著大于对照组(4.71±0.41 vs.3.93±0.24 mm,P<0.001),ROC曲线分析显示ONSD预测IIH的最佳临界值为4.25 mm(AUC=0.978,95%CI 0.95~1.00,P<0.001,敏感性:90%,特异性:93%)。在CVST组中,19例(76%)患者的颅内压(ICP)升高。ICP升高的患者ONSD显著高于ICP未升高的患者(4.35±0.22 vs.3.96±0.18 mm,P<0.001)。CVST患者的颈内静脉BFV(404.43±314.73 mL/min)显著低于对照组(680.37±233.03 mL/min,P<0.001)和IIH患者(617.67±282.96 mL/min,P=0.023)。ROC曲线分析显示BFV预测CVST的最佳临界值为471.6 ml/min(AUC=0.841,95%CI 0.73~0.95,P<0.001,敏感性:88%,特异性:72%)。IJVVI在病例组和对照组之间的发生率无统计学差异。结论眼-颈一体超声可以无创、实时动态评估颅内压及颈内静脉血流动力学改变。超声测量ONSD可以识别颅内压增高的患者,而颈内静脉血流量降低可能有助于区分CVST和IIH。

Objective The clinical presentation of cerebral venous sinus thrombosis(CVST)overlaps with that of idiopathic intracranial hypertension(IIH),but no screening tool exists.We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST.Methods Twenty IIH patients,25 CVST patients,and 40 healthy controls were retrospectively analyzed.The ultrasonographic optic nerve sheath diameter(ONSD)and hemodynamic characteristics of the internal jugular veins(IJVs)were recorded.The cerebrospinal fluid opening pressure was measured after ultrasonic examination.Results The ONSD was significantly larger in IIH patients than in controls(4.71±0.41 vs.3.93±0.24 mm,P<0.001).The ONSD cut-off for IIH diagnosis was 4.25 mm(AUC=0.978,95%CI 0.95~1.00,P<0.001,sensitivity:90%,specificity:93%).In the CVST group,19(76%)patients had elevated intracranial pressure(ICP);the mean ONSD was significantly higher in patients with increased ICP than in those without(4.35±0.22 vs.3.96±0.18 mm,P<0.001).The mean blood flow volume(BFV)was significantly reduced in CVST patients(404.43±314.73 mL/min)compared to that in controls(680.37±233.03 mL/min,P<0.001)and IIH patients(617.67±282.96 ml/min,P=0.008).The optimal BFV cut-off for predicting CVST was 471.60 ml/min(AUC=0.841,95%CI 0.73~0.95,P<0.001,sensitivity:88%,specificity:72%).No difference in frequency of IJVVI between patients and controls.Conclusion Eye-neck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs.ONSD measurement can identify patients with increased ICP,and reduced IJV BFV may aid the differentiation of CVST and IIH.