Non-invasive evaluation of intracranial pressure by transcranial Doppler ultrasound in patients with traumatic brain injury

doi:10.3969/j.issn.1672-6731.2020.07.006

Abstract

Abstract:

Objective To investigate the non-invasive evaluation of intracranial pressure (ICP) by transcranial Doppler ultrasound (TCD) in patients with traumatic brain injury (TBI). Methods The clinical data of 68 patients with TBI were retrospectively analyzed. Pulsatility index (PI) and optic nerve sheath diameter (ONSD) were performed by TCD, simultaneous recording of ICP parameter one week after surgery. The relationship between ONSD, PI and ICP was analyzed by Pearson correlation analysis. The area under the curve (AUC) was used to evaluate the diagnostic sensitivity of ONSD and PI for prediction intracranial hypertension. Results One week after surgery, ICP was positively correlated with ONSD (r=0.679, P=0.000). There was also a positive correlation between ONSD and ICP ≥ 20 mm Hg (r=0.665, P=0.000) and ICP < 20 mm Hg (r=0.358, P=0.006). The positive correlation remained between ONSD and ICP at ONSD ≥ 5 mm (r=0.644, P=0.000). There was a positive correlation between ICP and PI (r=0.458, P=0.000), so does the correlation at ICP 15-20 mm Hg (r=0.705, P=0.000) and ICP ≥ 20 mm Hg (r=0.716, P=0.000). The positive correlation still remained between ICP and PI < 1.20 (r=0.282, P=0.029) and PI ≥ 1.20 (r=0.350, P=0.021). For prediction intracranial hypertension, the AUC value was 0.900 (95%CI:0.831-0.969, P=0.000) for ONSD ≥ 5 mm, with sensitivity 0.821 and specificity 0.931, and the critical value of ONSD was 5 mm; the AUC value was 0.729 (95%CI:0.623-0.834, P=0.000) for PI ≥ 1.20, with sensitivity 0.483 and specificity 0.860, and the critical value of PI was 1.20; while the AUC value was 0.943 (95% CI:0.866-1.000, P=0.000) for a combination of ONSD ≥ 5 mm and PI ≥ 1.20, with sensitivity 1.000 and specificity 0.857, respectively. Conclusions ONSD and PI could be the non-invasive evaluation of ICP level, but the degree of correlation with ICP varies at different levels of ICP. It is necessary to understand the meaning of the parameters according to the pathophysiology of TBI and then guide the clinical treatment.

Key words: Brain injuries, traumatic, Intracranial pressure, Optic nerve, Middle cerebral artery, Hemodynamics, Ultrasonography, Doppler, transcranial

摘要：

目的探讨颅脑创伤患者TCD无创性评估颅内压的敏感性、特异性和诊断准确性。方法对2018年1月至2019年3月行开颅血肿清除术和有创性颅内压（ICP）监测的68例颅脑创伤患者行术后TCD无创性颅内压评估，同时记录双侧大脑中动脉搏动指数（PI）和视神经鞘直径（ONSD）；Pearson相关分析探讨ONSD和PI与颅内压之间的相关性，绘制受试者工作特征曲线（ROC曲线）、计算ONSD和PI诊断颅内压增高的灵敏度和特异度。结果术后1周颅内压与ONSD呈正相关（r=0.679，P=0.000），且ICP ≥ 20和< 20 mm Hg时与ONSD均呈正相关（r=0.665，P=0.000；r=0.358，P=0.006）；而仅ONSD ≥ 5 mm时与颅内压呈正相关（r=0.644，P=0.000）。颅内压与PI亦呈正相关（r=0.458，P=0.000），且ICP ≥ 20和15~20 mm Hg时均与PI呈正相关（r=0.716，P=0.000；r=0.705，P=0.000）；PI ≥1.20和 < 1.20与颅内压均呈正相关（r=0.350，P=0.021；r=0.282，P=0.029）。ROC曲线显示，ONSD诊断颅内压增高（ICP ≥ 20 mm Hg）的曲线下面积为0.900（95% CI：0.831~0.969，P=0.000），灵敏度为0.821、特异度0.931，临界值为5 mm；PI诊断ICP ≥ 20 mm Hg的曲线下面积为0.729（95% CI：0.623~0.834，P=0.000），灵敏度为0.483、特异度0.860，临界值为1.20；ONSD ≥ 5 mm联合PI ≥ 1.20诊断ICP ≥ 20 mm Hg的曲线下面积为0.943（95% CI：0.866~1.000，P=0.000），灵敏度为1.000、特异度0.857。结论 TCD监测参数（ONSD和PI）可以反映颅内压水平，但其与颅内压的相关程度在不同颅内压水平下有所差异，应根据病理生理学改变合理解读监测指标，进而指导临床治疗。

关键词: 脑损伤, 创伤性, 颅内压, 视神经, 大脑中动脉, 血流动力学, 超声检查, 多普勒, 经颅

CHANG Tao, GAO Li, YANG Yan-long, LI Li-hong. Non-invasive evaluation of intracranial pressure by transcranial Doppler ultrasound in patients with traumatic brain injury[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(7): 591-596.

常涛, 高立, 杨彦龙, 李立宏. 经颅多普勒超声无创性评价颅脑创伤患者颅内压的临床研究[J]. 中国现代神经疾病杂志, 2020, 20(7): 591-596.

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